Acute hemorrhagic leukoencephalitis

MRIs obtained from a comatose patient. Axial fluid-attenuated inversion recovery (FLAIR) images (top panels) show extensive white matter abnormal signal intensities in both hemispheres and in white matter adjacent to the insular cortices and olfactory gyri. Axial T2-weighted sequences (lower panels) show bihemispheric signal abnormalities as well as abnormalities of the medial temporal lobes with mass effects. Arrows indicate focus of reduced signal, consistent with hemorrhage. Clinical details of the case and parts of the composite figure have been published. (Gibbs WN, Kreidie MA, Kim RC, Hasso AN. Acute hemorrhagic leukoencephalitis. Neuroimaging features and neuropathologic diagnosis. J Comput Assist Tomogr 2005;29:689-93.) (Contributed by A Hasso, University of California, Irvine.)