Abstract：
A man in his 50s presented with sudden onset expressive aphasia and right-sided facial droop after experiencing coryzal symptoms and malaise for 7 days prior to admission. A brain MRI showed a rapidly progressive mass effect across both hemispheres and cerebrospinal fluid analysis revealed neutrophil predominance with raised protein levels. Acute disseminated encephalomyelitis was provisionally diagnosed, and high-dose methylprednisone was initiated.On admission to the high dependency unit, the patient tested positive for COVID-19 and was treated with appropriate therapeutic agents for severe COVID-19. A subsequent brain biopsy confirmed a demyelinating process, strongly indicating a diagnosis of acute haemorrhagic leucoencephalitis when correlated with the presence of severe oedema on imaging. Nine sessions of plasma exchange were provided over 18 days.At the time of writing, the patient has made an excellent recovery. We urge clinicians to consider this diagnosis and these treatment options for an otherwise devastating condition.
摘要：
一名50多岁的男子在入院前7天出现棒状症状和不适后，出现突然发作的表现性失语症和右侧面部下垂。脑MRI显示两个半球的快速进行性质量效应，脑脊液分析显示中性粒细胞占优势，蛋白质水平升高。急性播散性脑脊髓炎被临时诊断，开始大剂量甲基强的松.被高度依赖单位录取后，患者COVID-19检测呈阳性，并接受了治疗严重COVID-19的适当治疗剂。随后的脑活检证实了脱髓鞘过程，在影像学上与严重水肿相关时，强烈表明诊断为急性出血性白叶脑炎。在18天内提供了9次血浆置换。在撰写本文时,病人恢复得很好。我们敦促临床医生考虑这种诊断以及其他破坏性疾病的治疗选择。
