Mild Encephalitis/encephalopathy With Reversible Splenial Lesion Research Articles

Reversible splenial lesion syndrome associated with SARS-CoV-2 infection in two children

BackgroundReversible splenial lesion syndrome (RESLES) is characterized by a temporary lesion in the splenium of the corpus callosum, emerging related to encephalitis, seizures, antiepileptic drug withdrawal, or metabolic disturbances. Among RESLES, mild encephalitis/encephalopathy with reversible splenial lesion (MERS) has been defined as a distinct clinicoradiologic syndrome associated with viral infections. Case presentationWe report two children with multisystem inflammatory syndrome-children related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed RESLES during the disease course. Encephalopathy was the main central nervous system symptom. Both of the children showed a rapid recovery, and brain magnetic resonance imaging revealed complete resolution of the splenial lesion within 1 week. ConclusionThe complete resolution of the splenial lesion and rapid recovery from encephalopathy in RESLES associated with SARS CoV-2 were similar to observed in MERS.

MER… avigliosamente Scompare: Mild Encephalitis/encephalopathy with Reversible Splenial lesion

A case of mild encephalitis/encephalopathy with reversible splenial lesion (MERS) in a child.

Thermolabile polymorphism of carnitine palmitoyltransferase 2: A genetic risk factor of overall acute encephalopathy

ObjectivesAcute encephalopathy is an acute brain dysfunction after preceding infection, consisting of multiple syndromes. Some syndromes, such as acute encephalopathy with biphasic seizures and late reduced diffusion (AESD), are severe with poor outcome, whereas others, such as clinically mild encephalitis/encephalopathy with reversible splenial lesion (MERS), are mild with favorable outcome. Previous study reported the association of the thermolabile polymorphism in Carnitine Palmitoyltransferase 2 (CPT2) gene and severe syndromes of acute encephalopathy. To further explore the pathogenetic role of CPT2 in acute encephalopathy, we conducted a case-control association study of a typical thermolabile CPT2 polymorphism, rs2229291, in 416 patients of acute encephalopathy, including both severe and mild syndromes. MethodsThe case cohort consisted of 416 patients, including AESD, MERS, and other syndromes. The control subjects were 100 healthy Japanese. rs2229291 was genotyped by Sanger sequencing. Genetic distribution was compared between the patients and controls using Cochran-Armitage trend test. ResultsMinor allele frequency of rs2229291 was significantly higher in AESD (p = 0.044), MERS (p = 0.015) and entire acute encephalopathy (p = 0.044) compared to the controls. The polymorphism showed no significant association with influenza virus, or with outcome. ConclusionsThis study provided evidence that CPT2 is a susceptibility gene for overall acute encephalopathy, including both severe and mild syndromes, and suggested that impairment of mitochondrial metabolism is common to various syndromes of acute encephalopathy.

Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) in adults-a case report and literature review

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.

Gastroenteritis associated encephalopathy with reversible splenial lesion: three cases

Aims: Encephalopathy with or without seizures is a complication of gastroenteritis seen mainly in rotavirus infection. In some rare cases of rotavirus or adenovirus infection associated encephalopathy a reversible splenial lesion is described. This combination is called MERS (mild encephalitis/encephalopathy with reversible splenial lesion) and has a favourable outcome.

A case of infantile mumps meningitis with acute cerebellar ataxia and MERS

We report a patient with mumps meningitis and MERS (clinically mild encephalitis/encephalopathy with reversible splenial lesion) who exhibited flutter-like oscillations. A 7-year-old boy complaining of a headache, vomiting and dizziness consulted the Department of Pediatrics. Since he was positive for hemolytic streptococcus but did not exhibit cervical rigidity, an antibiotic was prescribed. He was brought back to the Department of Pediatrics after suffering from convulsions two days later. A high-intensity spot was found in the splenium of the corpus callosum on a diffusion-weighted magnetic resonance imaging (MRI) examination. The patient showed irregular horizontal eye movements and was referred to our department under a suspicion of peripheral vertigo. We found a horizontal pendular ocular movement with a small oscillation and a short duration and suspected flutter-like oscillations. No new lesions were found on a subsequent MRI examination, and the symptoms gradually improved without any additional treatment. The patient was discharged 20 days later. The diagnosis was mumps meningitis, acute cerebellar ataxia, and MERS based on a cerebrospinal fluid polymerase chain reaction (PCR) test and the MRI results. The patient's symptoms had disappeared at a follow-up examination performed in the outpatient department 47 days later.Flutter-like oscillations are an irregular ocular movement found in cases with an impaired brainstem or cerebellum. Flutter-like oscillations often occur with changes in fixation and are presumably caused by a malfunction in pause neurons in the brainstem.MERS is characterized by a reversible splenial lesion of high intensity on diffusion-weighted MRI in association with various diseases such as viral infection, epilepsy, renal failure and electrolyte imbalance. The cause is thought to involve inflammatory infiltrates or intramyelinic edema.The present report is thought to be the first description of a case of MERS exhibiting flutter-like oscillations. Since flutter-like oscillations may be confused with peripheral nystagmus, despite the distinctive ocular movement, a neurootologist consultation is desirable, especially in cases where central impairment is suspected.