ACUTE POSTINFECTIOUS LEUKOENCEPHALITIS IN PEDIATRIC-PATIENTS - A REVIEW OF 5 CASES

Acute postinfectious leukoencephalitis is a distinctive entity separat ed from the other forms of acute postinfectious encephalitis by the pr edominance of the lesions in the white matter of the central nervous s ystem. This inflammatory demyelinating condition usually occurs follow ing a viral infection, The five pediatric cases presented herein illus trate the typical clinical picture, with gradual development, in the w ake of an infectious episode, of constitutional symptoms associated wi th a variety of neurological manifestations : headache, pyramidal and extrapyramidal findings, cerebellar dysfunction, cranial nerve palsies , and obtundation or coma. Cerebrospinal fluid studies usually showed lymphocytosis, and an oligoclonal pattern was seen in two cases. Magne tic resonance imaging was very effective in demonstrating the diffuse lesions in the supra- and infra-tentorial white matter, and also often showed lesions in the brain stem and basal ganglia, Corticosteroid th erapy was effective, although neuropsychological sequelae were seen in one patient. The radiologic alterations faded gradually over time, an d the oligoclonal pattern also disappeared in the two patients with th is abnormality, The main differential diagnosis in this monophasic dis ease is multiple sclerosis, and in some cases only the course during p rolonged follow-up can establish the distinction.