Acute leukoencephalopathy with restricted diffusion

Last revised by Rohit Sharma on 5 Feb 2024

Acute leukoencephalopathy with restricted diffusion (ALERD) is a clinicoradiological spectrum of disease with clinical features of leukoencephalopathy and associated imaging findings where diffusion restriction is the dominant finding.

Radiographic features

The dominant radiological feature is diffusion restriction, predominantly in the subcortical white matter, described as the 'bright tree appearance' 3. Imaging in the first 48-72 hours following symptoms onset is usually normal and is followed by subcortical diffusion restriction between the 3rd and 9th day following symptom onset 1.

Differential diagnosis

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