# Bilateral Cerebellar Hemorrhages: An Atypical Presentation of Acute Hemorrhagic Encephalomyelitis

## TL;DR

A rare brain condition called acute hemorrhagic encephalomyelitis can mimic stroke and is diagnosed using MRI, with early treatment improving outcomes.

## Contribution

This paper presents a case where early detection and treatment of AHEM led to a successful recovery.

## Key findings

- AHEM can present with seizures and a declining GCS score.
- MRI is crucial for diagnosing AHEM despite its non-specific findings.
- Treatment with steroids and plasmapheresis improved patient outcomes.

## Abstract

Hurst disease, or Weston-Hurst syndrome, or acute hemorrhagic encephalomyelitis (AHEM), is an infrequent condition that usually gets provoked after a viral infection (respiratory tract infection) or, as reported in many case reports, post-vaccination. Hurst disease is a difficult-to-diagnose condition because it mimics common presentations such as stroke, decreased or loss of consciousness, brain abscess, and seizures, making clinical diagnosis challenging. Radiological imaging, such as magnetic resonance imaging (MRI) of the brain with diffusion-weighted imaging, now serves as the primary modality to identify such conditions, despite its lack of specificity. The treating doctor needs to do an in-depth analysis of the patient's history, as this carries a very high mortality rate. We hereby discuss a case that presented with seizures and deteriorating Glasgow Coma Scale (GCS) score, on imaging revealed posterior circulation acute hemorrhagic leukoencephalitis (AHLE)/AHEM, therein treated with steroids, plasmapheresis resulted in a good outcome implicating, early detection and timely management can reduce the mortality due to this condition.