Reversible Splenial Lesion Syndrome Research Articles

Deciphering Seizure Semiology in Corpus Callosum Injuries: A Comprehensive Systematic Review with Machine Learning Insights

IntroductionSeizure disorders have often been found to be associated with corpus callosum injuries, but in most cases, they remain undiagnosed. Understanding the clinical, electrographic, and neuroradiological alternations can be crucial in delineating this entity. ObjectiveThis systematic review aims to analyze the effects of corpus callosum injuries on seizure semiology, providing insights into the neuroscientific and clinical implications of such injuries. MethodsAdhering to the PRISMA guidelines, a comprehensive search across multiple databases, including PubMed/Medline, NIH, Embase, and Cochrane Library, was conducted. Studies on seizures associated with corpus callosum injuries, excluding other cortical or sub-cortical involvements, were included. Machine learning (Random Forest) and deep learning (1D-CNN) algorithms were employed for data classification. ResultsOut of 1250 initially identified articles, 41 studies met the inclusion criteria, encompassing 56 cases. The most frequent clinical manifestations included generalized tonic-clonic seizures, complex-partial seizures, and focal seizures. The most common callosal injuries were related to reversible splenial lesion syndrome and cytotoxic lesions. Machine learning and deep learning analyses revealed significant correlations between seizure types, semiological parameters, and callosal injury locations. Complete recovery was reported in the majority of cases post-treatment. ConclusionCorpus callosum injuries have diverse impacts on seizure semiology. This review highlights the importance of understanding the role of the corpus callosum in seizure propagation and manifestation. The findings emphasize the need for targeted diagnostic and therapeutic strategies in managing seizures associated with callosal injuries. Future research should focus on expanding the data pool and exploring the underlying mechanisms in greater detail.

Concurrent reversible splenial lesion syndrome and extrapontine osmotic demyelination syndrome associated with hypernatremia.

Concurrent reversible splenial lesion syndrome and extrapontine osmotic demyelination syndrome associated with hypernatremia.

Brain magnetic resonance imaging findings in children with neurological complications of coronavirus disease 2019 (Omicron variant): a multicenter retrospective observational study.

An increasing rate of encephalopathy associated with coronavirus disease 2019 (COVID-19) has been observed among children. However, the literature on neuroimaging data in children with COVID-19 is limited. To analyze brain magnetic resonance imaging (MRI) of pediatric COVID-19 patients with neurological complications. This multicenter retrospective observational study analyzed clinical (n=102, 100%) and neuroimaging (n=93, 91.2%) data of 102 children with COVID-19 infections and comorbid acute neurological symptoms. These children were hospitalized at five pediatric intensive care units (PICUs) in China between December 1, 2022, and January 31, 2023. All patients were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as detected via reverse transcriptase polymerase chain reaction. About 75.7% of the children were infected with the Omicron variant BF.7 strain. Brain MRI was performed 1-12 days following the onset of neurological symptoms, which revealed acute neuroimaging findings in 74.2% (69/93) of cases, including evidence of acute necrotizing encephalopathy (33/69, 47.8%), encephalitis (31/69, 44.9%), reversible splenial lesion syndrome (3/69, 4.3%), reversible posterior leukoencephalopathy (1/69, 1.4%), and hippocampal atrophy (1/69, 1.4%). Overall, these data highlighted five neuroimaging patterns associated with the outbreak of the SARS-CoV-2 Omicron variant, with acute necrotizing encephalopathy being the most common of these neuroimaging findings. Rarely, the brain MRI of these pediatric COVID-19 patients also demonstrate hippocampal atrophy.

Reversible splenial lesion syndrome in children: a retrospective study of 130 cases.

Reversible splenial lesion syndrome (RESLES) is a new clinico-radiological syndrome. We retrospectively analyzed the clinical features of 130 children with RESLES in China, which is the largest case series available in the literature. The clinical data of children diagnosed as RESLES in Jiangxi Provincial Children's Hospital between 2017 and 2023 were retrospectively analyzed. The 130 cases were divided into two groups: ≤ 3 years old group (group A) (n = 83) and > 3 years old group (group B) (n = 47). The chi-squared test or Fisher's test was used to evaluate the data. The vast majority of patients (127/130 cases, 97.7%) had prodromal symptoms of infection. Preceding infections of the gastrointestinal tract were statistically more significant in group A (60/83, 72.3%) than in group B (11/47, 23.4%) (P < 0.05). Preceding infections of the respiratory tract were statistically more significant in group B (33/47, 70.2%) than in group A (17/83, 20.5%) (P < 0.05). Seizures were statistically more significant in group A (82/83, 98.8%) than in group B (24/47,51.1%) (P < 0.05). The disturbance of consciousness and headache/dizziness were statistically more significant in group B (27/47, 57.4%; 37/47, 78.7%) than in group A (3/83, 3.6%; 1/83, 1.2%), respectively (P < 0.05). Convulsions with mild gastroenteritis (CwG) were statistically more significant in group A (50/83, 60.2%) than in group B (8/47, 17.0%) (P < 0.05). However, encephalitis/encephalopathy was statistically more significant in group B (20/47, 42.6%) than in group A (10/83, 12.0%) (P < 0.05). MRI showed cytotoxic edema in typical locations (RESLES type-1 limited to the splenium of the corpus callosum and RESLES type-2 spread to the entire corpus callosum, adjacent white matter, or both). There was full recovery of the lesions of MRI in all cases from 3 days to 50 days after the initial examinations. All the children showed normal neurodevelopment. Infection was the most common cause of RESLES. Infections of the gastrointestinal tract are common in ≤ 3 years old children, while infections of the respiratory tract are common in >3 years old children. Younger patients are more likely to develop convulsions, and older children were more likely to have symptoms with disturbance of consciousness and headache/dizziness. RESLES has characteristic MRI manifestations and a good prognosis.

Reversible Splenial Lesion Syndrome Associated with Encephalitis/Encephalopathy Improved with Short-Term Steroid Treatment

Reversible splenial lesion syndrome (RESLES) is a complex clinicoradiological entity that has been reported to occur secondary to several disorders, including acute encephalitis/encephalopathy. On magnetic resonance imaging, it presents as reversible hyperintense signal lesions on diffusion-weighted images and hypointense on apparent diffusion coefficient images. Most case of RESLES associated with encephalitis/encephalopathy have a good prognosis, but some require intensive care or have poor prognosis. We report a case of RESLES associated with encephalitis/encephalopathy in which neurological deterioration improved after steroid treatment.

Reversible Splenial Corpus Callosum Lesion and Carbamazepine

Introductıon&#x0D; Reversible splenial lesion syndrome (RESLES) at corpus callosum (CC) has been defined in many clinical conditions. Although the etiopathogenesis of transient focal lesions in the CC splenium has not been clarified, many theories remain on the agenda, especially in epilepsy patients.&#x0D; Case&#x0D; A 38-year-old male patient with idiopathic generalized epilepsy was admitted to the emergency department with complaints of frequent seizures. It was reported by his relatives that he had stopped carbamazepine treatment for the last three days. After his last epileptic attack, he had been headache, nausea, vomiting, decreased visual acuity, and prolonged confusion. The patient with diffusion restriction at the level of splenium CC in magnetic resonance imaging (MRI), whose seizure frequency increased, was evaluated by a neurology doctor. In his electroencephalography, spike waves were observed in both hemispheres, which were frequently generalized. The same lesion was not observed in the diffusion and MRI taken eight days later in the patient who had no seizures in the follow-up.&#x0D; Discussion&#x0D; Studies have shown that CC damage results in the disruption of cortical functions, with disconnection of the cerebral hemispheres and disturbances in consciousness. The clinical spectrum includes a fairly wide symptomatology. RESLES of the CC is an infrequent finding on MRI. Some of these lesions are associated with epileptic seizures, the sudden withdrawal of the antiepileptic drug, or usage.&#x0D; Conclusion&#x0D; RESLES, which we reviewed with etiology and clinical findings, still remains a mystery. It will be clarified with wide-ranging studies.

Reversible Splenial Lesion Syndrome (RESLES) in Sickle Cell Crisis Mimicking Marchiafava-Bignami Disease (P10-7.001)

<h3>Objective:</h3> N/A <h3>Background:</h3> Reversible Splenial Lesion Syndrome (RESLES) is characterized by the presence of transient lesion involving the splenium of corpus callosum in patients with encephalopathies of various cytotoxic etiologies. One of which is Marchiafava-Bignami Disease(MBD), which could manifest with sudden stupor or coma in alcohol use disorder (AUD) or malnutrition with severe demyelination of splenium. Here we report a case of MBD-like presentation in a patient with vaso-occlusive sickle-cell crises. <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 46-year-old male with sickle-cell disease and no history of AUD presented with acute chest syndrome with pain crisis. He was treated with blood transfusion and analgesics. Two days later, he became acutely unresponsive with right-sided hemiparesis, requiring intubation. MRI brain showed numerous punctate infarcts in the watershed areas bilaterally, along with symmetric diffusion restriction in the splenium of corpus callosum, respecting its anatomic boundary. Exchange transfusion was initiated and maintained his hemoglobin &gt;10 g/dL and Hb-SS &lt; 30%, but he remained comatose (GCS 6). Electroencephalogram showed diffuse cerebral dysfunction without epileptogenicity. His extensive infectious workup was unremarkable. Other laboratory tests including electrolytes, liver function tests, ammonia, thyroid function tests, vitamin B12, B6, folic acid, and thiamine levels were normal. He was empirically treated with intravenous thiamine. One week later, his mental status improved to following commands. MRI brain two weeks after showed a near-complete resolution of the callosal lesion. The patient’s acute stupor/coma and MRI findings were attributed to hypoxic watershed infarcts and RESLES due to hypoxic stress from vaso-occlusive sickle cell crisis, leading to a transient coma, mimicking MBD. <h3>Conclusions:</h3> RESLES is a distinct syndrome with characteristic radiographic finding of diffusion restriction in the splenium of corpus callosum due to cytotoxic edema of various etiologies. MBD is one such example, presenting with stupor/coma. This case emphasizes the importance of identifying reversible metabolic stressors, including sickle cell crisis. <b>Disclosure:</b> Dr. Mulatu has nothing to disclose. Dr. Yoon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ECHAS. Dr. Ramaswamy has nothing to disclose. Dr. Mulatu has nothing to disclose. Cappi C Lay has received publishing royalties from a publication relating to health care.

Reversible splenial lesion after surgery for distant arteriovenous malformation: a case report.

Isolated lesions of the corpus callosum are rare and may represent permanent but also transient responses to various pathology termed "reversible splenial lesion syndrome" (RESLES) when in light of relevant clinical presentation. We present the first case of the RESLES after elective surgery for distant arteriovenous malformation (AVM), followed by a slight speech disturbance and MRI verified small, oval, well-circumscribed area of apparent cytotoxic edema in the center of the corpus callosum splenium, which completely resolved within 15days. Surgery for AVM is followed by the complex adaptation to a new vascular pattern, RESLES might develop, and should be suspected.

Radiological findings of multisystem inflammatory syndrome in children associated with COVID-19.

To retrospectively evaluate the imaging and clinical findings of patients diagnosed with multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. The clinical, laboratory and radiological data of 110 patients (74 male and 36 female) diagnosed with COVID-19-related MIS-C between June 2020 and November 2021 were evaluated retrospectively. Cases with a diagnosis of MIS-C based on a positive real time polymerase chain reaction (RT-PCR) test or serology results according to the WHO criteria were included in the study. All the radiological data were evaluated by a pediatric radiologist with 14 years of radiology experience. Peribronchial thickening and hyperinflation were the most common findings on chest X-ray, while atelectasis and pleural effusion were often present in thoracic CT. Cardiac involvement was detected in 30% of the patients, mainly with valve insufficiency and systolic dysfunction, and 7.2% of these patients had sequalae findings. The most common abdominal findings were hepatosplenomegaly, mesenteric inflammation, lymphadenomegaly, thickening of the intestinal walls and free fluid. 23 of the patients had comorbidities. Neurological radiological findings observed in a total of six patients were reversible splenial lesion syndrome, posterior reversible encephalopathy syndrome, meningitis, and cerebral edema. 37 patients were followed up in the intensive care unit and 2 of them died. Radiological findings seen in MIS-C vary according to the affected system. There is no specific radiologic finding for this disease, but radiological findings can assist in the evaluation of affected systems and guide treatment. Since there are few studies with a limited number of patients in the literature, data on this subject are limited. We aimed to contribute to the literature with our large patient data.

Reversible Splenial Lesion Syndrome developing in the setting of sleep deprivation

In this report, we present a rare case of reversible splenial lesion syndrome which was etiologically associated with sleep deprivation. Up to our knowledge, there is no previous research reporting sleep deprivation as an inducer agent of RESLES. To elucidate our observation, future reports of larger case series are surely warranted. The clarification of the possible association between sleep deprivation and the reversible splenial lesion may also provide substantial perspectives regarding the mechanisms and health impact of sleep deprivation; the functional and pathophysiological role of the splenial corpus callosum in sleep physiology. Besides, we think that the awareness of this entity should increase among clinicians to avoid unnecessary investigations as the case in our patient.

Local glucose metabolism is unaltered in reversible splenial lesion syndrome.

Transient splenial oedema, also known as reversible splenial lesion syndrome (RESLES), is a rare magnetic resonance imaging (MRI) finding that presents as a round or ovoid focal oedema in the posterior corpus callosum, and is associated with a wide range of clinical conditions. The aetiology of RESLES is not fully clear. We aimed to investigate conflicting pathophysiological hypotheses by measuring local glucose metabolism in patients with RESLES. We retrospectively analysed patients with RESLES after reductions in antiseizure medications during in-hospital video electroencephalography monitoring. We measured local glucose uptake using positron emission tomography/computed tomography and compared matched cohorts of patients with and without MRI evidence of RESLES using nonparametric tests. Local glucose metabolism in the splenium of seven patients with RESLES was not significantly different from the glucose metabolism of the seven patients in the matched cohort. This was true using both regular and normalized standardized glucose uptake value calculation methods (p=0.902 and p=0.535, respectively). We found no evidence of local glucose hypometabolism in RESLES, which supports previous pathophysiological considerations that suggest that RESLES is an intercellular, intramyelinic oedema rather than a typical intracellular cytotoxic oedema, which is not reversible.

Rituximab‐induced mild encephalopathy with a reversible splenial lesion syndrome (MERS): An adverse effect to add to the list

Mild encephalopathy with a reversible splenial lesion syndrome (MERS) is a rare clinico-radiological entity. Rituximab (RTX)-induced MERS has never been described before. Herein, we report the case of a 33-year-old patient diagnosed since 2017, with an IgG4-related disease (IgG4-RD). This diagnosis was retained in the face of a prolonged fever, sicca syndrome, hepatic damage and renal pseudotumour associated to a high level of IGg4 at 2.8g/L with suggestive renal histology. The patient was treated with corticosteroid therapy with persistence of renal impairment and nephrotic syndrome indicating RTX therapy. The patient received his first dose of RTX and presented neurological and respiratory impairments a few hours afterwards. An infectious investigation comprising a SARS CoV-2 PCR and viral PCRs (VZV, herpes and CMV) on cerebrospinal fluid (CSF) were negative. The HBV, HCV, HIV, Parvo B19, CMV, EBV, herpes, mycoplasma and syphilis serologies as well as Legionella antigenuria were also negative. The patient had received intravenous immunoglobulins (IVIG) and methylprednisone, associated with sodium valproate with favourable outcome. The diagnosis of MERS induced by RTX was retained in our patient according to clinical and radiological features. We herein report the first case of MERS following RTX in a patient treated for IgG4-RD.

RESLES — синдром оборотного ураження валика мозолистого тіла при вірусасоційованому енцефаліті

У статті наводиться опис клінічного випадку синдрому оборотного ураження валика мозолистого тіла (синдрому RESLES) у чоловіка 62 років на тлі вірусасоційованого енцефаліту. Синдром RESLES є гострою транзиторною енцефалопатією, що супроводжується минущими змінами валика мозолистого тіла за даними магнітно-резонансної томографії. Обговорюються основні етіологічні фактори, клінічна та нейровізуалізаційна картина, питання диференціальної діагностики, принципи лікування синдрому RESLES.

Fever, Seizures and Encephalopathy: From Bush Fires to Firestorms.

Fever-associated seizures and febrile encephalopathy are common neurological problems in children. Infections of the nervous system are responsible for the majority of cases. However, there is a spectrum of infection-associated and inflammatory conditions associated with the triad of fever, seizures, and encephalopathy. Apart from complex febrile seizures and febrile status epilepticus, fever infection-related epilepsy syndrome of childhood (FIRES), infantile hemiconvulsion hemiplegia epilepsy syndrome (IHHE), acute encephalopathy with delayed diffusion restriction (AESD), acute necrotizing encephalopathy of childhood (ANE), and reversible splenial lesion syndrome (RESLES) are age-related clinical phenotypes of fever-related epilepsy and encephalopathy. Awareness of these entities is important for appropriate diagnosis and the prompt use of immunomodulatory/immunosuppressive therapies. In this review, we discuss the pathophysiology, clinical phenotypes, and management approaches of these fever-related seizure and encephalopathy states.

Reversible lesion of the corpus callosum associated with COVID-19: A case report

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may affect the central nervous system and peripheral nervous system. Major central nervous system manifestations of SARS-CoV-2 infection include seizures, meningoencephalitis, ischemic stroke, anosmia, and hypogeusia. The reversible splenial lesion syndrome was first described in 2004. Although reversible splenial lesion syndrome was initially recognized as a benign phenomenon, a second type of reversible splenial lesion syndrome was identified in later years, which has a poorer prognosis and potentially serious sequela. Reversible splenial lesion syndrome can be caused by numerous etiologies including viruses. In this report, we present a rare case of COVID-19 with reversible splenial lesion, who presented with ataxia and dizziness.

Fulminant idiopathic intracranial hypertension and reversible splenial lesion syndrome (RESLES) : A case report

Reversible splenial lesion syndrome (RESLES) is a rare clinico–radiological entity characterized by transient lesions involving the splenium of the corpus callosum (SCC). It has been described in a broad spectrum of conditions. We report the case of a RESLES in a young woman ultimately diagnosed with fulminant idiopathic intracranial hypertension (IIH). To the best of our knowledge, this is the first such association reported.

Reversible splenial lesion syndrome with mental disorders as only manifestation

BackgroundReversible splenial lesion syndrome (RESLES) was reported to be associated with variable entities. However, much less is known about the cases in which the mental disorders act as the only manifestation.MethodTotal ten patients of RESLES were obtained in this retrospective study from Shenzhen Kangning Hospital. T1-fluid attenuated inversion recovery (T1-FLAIR), T2-weighted images, T2-FLAIR, diffusion-weighted images and apparent diffusion coefficient map were performed on all the patients. Clinical manifestations, laboratory examination results, magnetic resonance imaging (MRI) findings, treatments and outcomes were analyzed.ResultAll patients showed different mental disorders as the only manifestation. There were two cases of alcohol abuse, one of Asperger’s syndrome with malnutrition, one of infection and one of invasive pituitary adenoma. The other cases were diagnosis as major depressive disorder, dissociative and conversion disorders, undifferentiated somatoform disorder, unspecified psychosis and bipolar disorder, respectively. Three patients were completely recovered while the clinical symptoms of rest seven patients partially recovered at the follow-up three months later. Oval-shaped lesion centered on the splenial of corpus callosum (SCC) was observed in all patients using MRI. The lesions of SCC of all patients were completely resolved within five weeks.ConclusionsWe found that RESLES might only showed mental symptoms. On the one hand, for the patients with acute mental disorders, clinicians should be alert to the possibility of RESLES caused by physical disease. On the other hand, we suggest that mental disorder might be a precipitating factor of RESLES.

Clinical analysis of 23 cases of adult reversible splenial lesion syndrome

Clinical analysis of 23 cases of adult reversible splenial lesion syndrome

Imaging of Multisystem Inflammatory Disease in Children (MIS-C) Associated With COVID-19

Rationale and ObjectivesTo retrospectively evaluate imaging findings in multisystem inflammatory disease in children associated with COVID-19 (MIS-C).Materials and MethodsThe radiological imaging findings of 45 pediatric patients aged between 52 days and 16 years, who were diagnosed with MIS-C according to the World Health Organization (WHO) criteria, were evaluated. All the patients underwent chest X-ray and echocardiography. The findings obtained from 25 abdominal radiographs, 24 abdominal US, 7 abdominal CT, 16 thorax CT, 21 cranial MRI and one spinal MRI, MR cholangiography (MRCP) and cardiac MRI examinations were categorized and evaluated according to the affected systems.ResultsWhile the most common findings in chest X-ray were perihilar opacity and peribronchial thickening, pleural effusion was the most finding in thorax CT. Echocardiography findings of myocarditis were observed in 31% of the cases. The most common findings in abdominal radiological evaluation were hepatomegaly and splenomegaly, edema in the gallbladder wall and periportal area, mesenteric lymph nodes in the right lower quadrant, thickening of the intestinal walls, and free fluid. Reversible splenial lesion syndrome (RESLES) was the most common neurological finding. Acute disseminated encephalomyelitis (ADEM)-like lesions, acute hemorrhagic necrotizing encephalomyelitis, and radiological findings consistent with Guillain-Barré syndrome were found in one case each.ConclusionRadiological findings seen in MIS-C in pediatric cases are correlated with the affected system. According to the system involved, there is no specific finding for this disease. Radiological findings are not the primary diagnostic tool but can assist in the evaluation of the affected systems and to guide treatment.

A case of reversible splenial lesion syndrome secondary to Fanconi syndrome with white matter swelling as the main manifestation

Reversible splenial lesion syndrome (RESLES) is a rare clinical imaging syndrome that is characterized by magnetic resonance imaging (MRI) findings of reversible abnormal signals in the splenium of the corpus callosum (SCC). There are a variety of pathogenic causes, including infection, metabolic disturbances, and antiepileptic drug use. Moreover, the disease is clinically rare and easily misdiagnosed. Here, we report a unique case of a 32-year-old man with Fanconi syndrome who had an intensified signal in the SCC and diffuse white matter swelling on MRI. We believe this to be the first adult case of RESLES as a manifestation of Fanconi syndrome, which further expands the disease spectrum leading to RESLES. The imaging features of this case included extensive lesions, symmetrical diffuse restricted signals, and reversibility. The identification of these features improves our understanding of the imaging characteristics of RESLES, thus enabling clinicians to better understand this disease, correctly establish its diagnosis, and improve its prognosis in this kind of patient.