Fulminant acute hemorrhagic encephalomyelitis mimicking Guillain-Barré syndrome in a child: A fatal case report.

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.