Acute Necrotizing Hemorrhagic Excephalopathy

Abstract

The clinical and pathological findings in 4 cases of acute necrotizing hemorrhagic encephalopathy are presented. All of these occurred in the summer and autumn of 1946, at which time there was no epidemic of virus diseases of the nervous system. The illness was acute in each instance and the course was rapidly progressive. Fever, headache and stiff neck were prominent symptoms. The neurologic manifestations varied with the locality of the disease process. The spinal fluid was abnormal with a neutrophilic pleocytosis, elevated protein and normal or slightly reduced sugar. Postmortem examination of the brain disclosed large, asymmetric discolored lesions characterized by swelling and multiple hemorrhages. There was vascular necrosis with multiple small hemorrhages and neutro-philic infiltration of damaged tissues. Staphylococcus aureus was obtained from the brain and spinal fluid of one case, but in the others bacterial cultures and virus studies were negative. The possibility of an allergic reaction to a toxin or infective agent seems consistent with the pathologic findings.