ArticleRadiology case reports2026
Fulminant acute hemorrhagic encephalomyelitis mimicking Guillain-Barré syndrome in a child: A fatal case report.
Article in Radiology case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Acute hemorrhagic encephalomyelitis (AHE), or Weston Hurst disease, is vanishingly rare and almost always fatal. A fulminant variant of acute disseminated encephalomyelitis, it is defined by rapidly progressive demyelination, parenchymal necrosis, and hemorrhagic white matter destruction. Here we report a 4-year-old girl who arrived with ascending flaccid tetraparesis 1 week after a flu-like illness, a picture that, not unreasonably, pointed toward Guillain-Baré syndrome. Within 24 hours, the diagnosis collapsed: she developed impaired consciousness, bilateral Babinski signs, and dysphagia signs with no place in a peripheral neuropathy. Emergency brain and spinal MRI then showed the full picture: bilateral confluent T2/FLAIR white matter hyperintensities with susceptibility-weighted imaging (SWI)-confirmed hemorrhagic petechiae and parenchymal necrosis, consistent with AHE. High-dose corticosteroids and intravenous immunoglobulins were started immediately. She died on day 2. The lesson is uncomfortable but clear: normal CSF and an ascending paralysis do not rule out a central catastrophe. When central signs emerge-any of them-emergency MRI with SWI/T2* is non-negotiable.
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