Reply: Concentric demyelination pattern in COVID-19-associated acute haemorrhagic leukoencephalitis: A lurking catastrophe?

Ross W. Paterson, Rachel L. Brown, Vinojini Vivekanandam, Alexander J.M. Foulkes, Maria Thom, Sarah Wiethoff, Laura Benjamin, Gerry Christofi, Patricia McNamara, Jasper Morrow, Thomas D. Miller, Ross Nortley, Ruth Geraldes, David Attwell, Guru Kumar, Alex D. Everitt, Nicholas W.S. Davies, S. Anand Trip, Eli Silber, Robin HowardRichard J. Perry, David J. Werring, Anna Checkley, Nicky Longley, Jennifer Spillane, Michael P. Lunn, Chandrashekar Hoskote, Hans Rolf Jäger, Hadi Manji, Michael S. Zandi, UCL Queen Square National Hospital for Neurology and Neurosurgery COVID-19 Study Group, Anthony Khoo

Research output: Contribution to journalLetterpeer-review


We are grateful to Karapanayiotides and colleagues (2020) for their description of a 57-year-old patient with acute haemorrhagic leukoencephalitis (AHLE) and concentric demyelination suggestive of Baló’s disease, and for adding insights into the neurological manifestations of COVID-19. The authors are correct to point out that the mechanisms underpinning the features in all of our collective patients remain to be determined, and the role of direct infection, hypoxia, immune-mediated injury and metabolic processes all warrant further exploration. The authors are also correct in describing the difficulty in applying historical terminology to the clinical pictures that we are now seeing in COVID-19, and that new terminologies need to be considered.

In Patient 17, the clinical picture of rapid progression, unilateral significant brain swelling with oedema and ensuing coma—with evidence of brainstem dysfunction, and resolution with decompressive craniectomy and corticosteroids, fitted best clinically with previous descriptions of haemorrhagic leukoencephalitis (AHLE) (Love et al., 2008)...
Original languageEnglish
Pages (from-to)e101
Number of pages2
Issue number12
Publication statusPublished - 1 Dec 2020
Externally publishedYes


  • ADEM
  • COVID-19
  • encephalitis
  • SARS-CoV-2


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