Clinical characteristics in four pediatric patients with mild encephalitis/encephalopathy with a reversible splenial lesion of corpus callosum

Abstract

Objective To investigate the clinical and imaging features of mild encephalitis/encephalopathy with a reversible splenial lesion of corpus callosum (MERS) in children. Methods Four patients of MERS, who were diagnosed and treated in the First Hospital of Jilin University during 2013–2014, were collected retrospectively. Their clinical, laboratory, radiologic data and the related literatures were reviewed. Results Four patients onsetted as gastrointestinal symptom (3 cases) or respiratory (1 case) symptom, in accompany with disturbance of consciousness (3 cases of drowsiness, 1 case of lethargy), convulsions (4 cases), headache (1 case) as the main symptoms. Abnormal neurological signs included positive cervical resistance (3 cases), positive bilateral Babinski sign (3 cases), bilateral chemosis (2 cases). Laboratory test showed the average blood sodium was 131.6 mmol/L, while the cerebrospinal fluid test only showed abnormality in 1 case. In etiology examination, 2 cases showed human rotavirus antigen positive, and Mycoplasma neumonia antibody was found positive in 2 cases. Cranial MRI showed reversible lesion in the splenium of corpus callosum (patchy iso- or hypo-intensity on T1WI and apparent diffusion coefficient, hyper-intensity on T2WI, FLAIR and DWI, clear boundary). After active treatment, clinical symptoms disappeared within 1 week, and cranial MRI lesions disappeared within 2 weeks. Conclusion The clinical presentations of MERS, which is a clinical-radiological syndrome, are sudden onset and mild, with characteristic changes in brain MRI and good prognosis. Key words: Encephalitis; Consciousness disorders; Seizures; Corpus callosum; Magnetic resonance imaging; Child