Abstract
BackgroundMild encephalitis/encephalopathy with reversible splenial lesion (MERS) is a rare clinico-radiological entity characterized by the magnetic resonance imaging (MRI) finding of a reversible lesion in the corpus callosum, sometimes involved the symmetrical white matters. Many cases of child-onset MERS with various causes have been reported. However, adult-onset MERS is relatively rare. The clinical characteristics and pathophysiologiccal mechanisms of adult-onset MERS are not well understood. We reviewed the literature on adult-onset MERS in order to describe the characteristics of MERS in adults and to provide experiences for clinician.MethodsWe reported a case of adult-onset MERS with acute urinary retension and performed literature search from PubMed and web of science databases to identify other adult-onset MERS reports from Januarary 2004 to March 2016. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed on selection process. And then we summarized the clinico-radiological features of adult-onset MERS.ResultsTwenty-nine adult-onset MERS cases were reviewed from available literature including the case we have. 86.2% of the cases (25/29) were reported in Asia, especially in Japan. Ages varied between 18 and 59 years old with a 12:17 female-to-male ratio. The major cause was infection by virus or bacteria. Fever and headache were the most common clinical manifestation, and acute urinary retention was observed in 6 patients. All patients recovered completely within a month.ConclusionAdult-onset MERS is an entity with a broad clinico-radiological spectrum because of the various diseases and conditions. There are similar characteristics between MERS in adults and children, also some differences.
Highlights
Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) is a rare clinico-radiological entity characterized by the magnetic resonance imaging (MRI) finding of a reversible lesion in the corpus callosum, sometimes involved the symmetrical white matters
Cranial MRI scans taken on the day after admission showed abnormal signals in splenium of the corpus callosum (SCC), which was hyperintense on T2-weighted images (T2WI) and diffusion-weighted images (DWI) imaging, decreased on apparent diffusion coefficient (ADC), isointense on T1weighted imaging (T1WI) with no contrast enhancement (Fig. 1)
Similar to child-onset MERS, most adult-onset MERS patients were reported in Asia, including Japan, China and India
Summary
Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) is a rare clinico-radiological entity characterized by the magnetic resonance imaging (MRI) finding of a reversible lesion in the corpus callosum, sometimes involved the symmetrical white matters. Many cases of child-onset MERS with various causes have been reported. Tada et al first identified the concept of mild encephalitis/ encephalopathy with reversible splenial lesion (MERS) as a rare clinico-radiological syndrome in 2004 [1, 2]. Many child-onset MERS cases have been reported, most in Asia, especially Japan [1, 15]. We reported a case of adult-onset MERS with acute urinary retention. It has been speculated that the characteristics of MERS in adults are different from that in children. We utilized this opportunity to review the literature on adult-onset MERS in order to describe the clinico-radiological features and establish a clinical position of the disease
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