The clinical spectrum of haemorrhagic CNS inflammatory demyelinating lesions

Mult Scler. 2022 Oct;28(11):1710-1718. doi: 10.1177/13524585221094241. Epub 2022 May 17.


Background: Haemorrhagic demyelinating lesions are rare, and little is known about the demyelinating diseases with which they are associated, or how lesional haemorrhage affects treatment and outcomes.

Objective: To examine the clinical characteristics and outcomes of patients with demyelinating lesions and magnetic resonance imaging (MRI) evidence of haemorrhage seen at the Mayo clinic between 1990 and 2018.

Methods: The Mayo Clinic's medical-record diagnostic-linkage system was used to identify patients with CNS demyelinating disease and parenchymal haemorrhage on brain MRI cross-referenced against a database of patients with pathologically confirmed CNS demyelinating disease. The clinical characteristics, diagnosis, MRI findings, brain histopathology, and outcomes of these patients were reviewed.

Results: Ten patients with haemorrhagic demyelination were identified, including three patients who underwent a brain biopsy. The main findings were that haemorrhagic demyelinating lesions most often occur in atypical forms of demyelination, especially acute haemorrhagic leukoencephalitis (AHL, or Weston-Hurst disease) and tumefactive demyelination, and rarely in multiple sclerosis. A spectrum of outcomes was observed for these patients ranging from complete remission through to high level disability.

Conclusion: Lesional haemorrhage is uncommon in demyelinating disease where it is most closely associated with AHL. Bleeding within a demyelinating lesion does not always herald a poor prognosis.

Keywords: Multiple sclerosis; acute disseminated encephalomyelitis; acute haemorrhagic leukoencephalitis; atypical demyelination; blood; haemorrhage; susceptibility weighted imaging; tumefactive demyelination.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain / diagnostic imaging
  • Brain / pathology
  • Demyelinating Diseases* / diagnosis
  • Hemorrhage
  • Humans
  • Magnetic Resonance Imaging / methods
  • Multiple Sclerosis* / pathology