Reversible Splenial Lesion Research Articles

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.

Nursing of a patient with reversible splenial lesion syndrome who has transient ischemic attack as the initial symptom

To report the nursing care of a case of patient with reversible splential lesion syndrome (RESLES) who has transient ischemic attack as the initial symptom. The examination revealed that the patient was secondary to viral encephalitis. The nursing points included the observation of the condition of RESLES, the safety nursing of transient ischemic attack and the nursing of viral encephalitis. Through active treatment and effective nursing, the patient′s symptoms were relieved obviously and the patient was discharged. Key words: Nursing; Ischemic attack, transient; Encephalitis, viral; Reversible splential lesion syndrome

Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion Due to Respiratory Syncytial Virus: Case Report

Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a rare clinico-radiological entity, which is characterized by transient abnormalities in the splenium of the corpus callosum (SCC) associated with mild central nervous system (CNS) symptoms. MERS is often described in children, unlike in adults, which is rare. Its etiologies are variable, dominated by infectious causes. Its reversibility and favorable prognosis make all the particularity of this syndrome.

Reversible splenial lesion with hemorrhage in cerebral cavernous malformations: a case report

Reversible splenial lesion with hemorrhage in cerebral cavernous malformations: a case report

Clinically Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion without Central Nervous System Disturbances: A Case Report

Patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) on the splenium of the corpus callosum (SCC) present with relatively mild central nervous system disturbances. A 41‐year‐old man was admitted with fever and headache and, his main symptoms were mild headache and fatigue. There were no neurological focal signs. Brain magnetic resonance imaging (MRI) showed abnormal signals in SCC. We report, for the first time, a MERS patient, detected on MRI, who did not present with central nervous system disturbances. Our experience suggests MERS should be considered as a differential diagnosis in patients with fever of unknown origin.

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion of corpus callosum in Chinese children

ObjectiveTo investigate the characteristics and etiology of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in Chinese children. MethodsWe collected ten pediatric MERS patients from local hospital and enrolled another nineteen patients by reviewing the available literatures. The information of enrolled patients about clinical features, laboratory data, treatment strategies and prognoses were collected for further analysis. ResultsA total of 29 children, the median age of twenty-nine patients was (4.09±3.64) years old. The male-to-female ratio was 1.42:1.0. The major cause of MERS was viral infection. 18 patients had consciousness disturbance which was the most prominent syndrome. 18 patients had transient seizures and only one needed anticonvulsant treatment for long. 9 patients were observed serum sodium levels <135mEq/L. The cells and protein of cerebral spinal fluid (CSF) were increased in 3 patients. In all patients, brain MRI evaluation revealed typical lesion in splenium of the corpus callosum (SCC). 5 patients had additional lesions involving the periventricular white matter or bilateral centrum semiovale diagnosed. 3 patients were treated with antivirus treatment because of virus infection. 7 patients received corticosteroid. 2 patients received intravenous IVIG. As a result, all patients had fully recovered without neurological residual. ConclusionsThe result of present study suggests that Chinese children with MERS might have favorable prognosis, although there is still no guideline for treatment.

“Symptomatic” infection-associated acute encephalopathy in children with underlying neurological disorders

BackgroundDevelopment of infection-associated acute encephalopathy (AE) is precipitated by several factors, including viral agents, age, and genetic polymorphisms. In addition, children with prior underlying neurological disorders can also present with AE. MethodWe reviewed 55 children with AE who were referred to hospitals participating in the Status Epilepticus Study Group from 1988 to 2013. AE was classified into eight subtypes: acute encephalopathy with biphasic seizures and late reduced diffusion (AESD); hemiconvulsion–hemiplegia syndrome (HH); acute necrotizing encephalopathy; hemorrhagic shock and encephalopathy syndrome (HSES); clinically mild encephalitis/encephalopathy with a reversible splenial lesion; acute encephalitis with refractory, repetitive partial seizures; Reye-like syndrome; and unclassified. ResultOf the 55 AE cases, 14 (25.4%) had underlying neurological disorders, including perinatal insults (n=6) and genetic syndrome and/or brain malformations (n=8). These preceding morbidities were relatively common in AESD (6/18, 33.3%), HH (3/9, 33.3%), and HSES (3/6, 50.0%). History of epilepsy or febrile seizures were frequent in HH cases (4/9, 44.4%), whereas they were rare in other AE subtypes. ConclusionAmong the AE subgroups, HH, HSES, and AESD frequently emerged in preceding etiologies with augmented neuronal excitability. These subgroups may have distinct pathomechanism from the “cytokine storm” mediated AEs during childhood.

Reversible splenial lesion syndrome in children: Retrospective study and summary of case series

ObjectiveTo describe clinical features of reversible splenial lesion syndrome (RESLES) in children. MethodsRetrospectively analyzed clinical features of RESLES in children and compared differences between severe and non-severe group, classified by clinical global impression-scale; summarized clinical features of children with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) from case series. Results16 episodes of RESLES occurring in 15 Chinese children were analyzed, with 13 episodes having MERS and 3 episodes with epilepsy. 10 episodes were associated with various pathogens including rotavirus (n=5), adenovirus (n=1), influenza A (n=1), mycoplasma (n=2), and jejunum campylobacter (n=1). The common neurological symptoms included seizure, behavioral changes, altered consciousness and motor deterioration. The lesions of splenium of corpus callosum (SCC), extra-SCC (n=2) or extra-CC (n=1) showed T2-weight and FLAIR hyper-intensity, with the corresponding reduced diffusion. All had complete resolution of radiological changes except 1 episode with small residual. 8 episodes had EEG abnormalities, while elevated white blood count, increased hs-CRP, and hyponatremia were commonly revealed. 7 episodes were given steroid plus therapy, while 3 episodes were treated with antiepileptic drugs. Compared with non-severe group, the number of patients with altered consciousness, EEG abnormalities, motor deterioration, or extra-SCC lesions in severe group was significantly increased. The patients in severe group tended to need longer hospital stay interval. No case caused neurological sequelae, except 1 patient in severe group with recurrent episode and extra-CC lesions having intellectual disability (ID). Five pediatric MERS case series were summarized, including 67 episodes (40 male and 27 female; age ranging 10 m∼13y) from 65 patients, with 33 episodes in Japan, 27 in China, and 7 in Caucasian Australian children, and all patients have a good prognosis except 1 patient with ID (current study). ConclusionAlthough RESLES in children tend to be a good outcome, the prognosis of patient in severe group, especially with extra-CC lesions, might have neurological sequelae.

Marked elevation of urinary β2-microglobulin in patients with reversible splenial lesions: A small case series

The magnetic resonance imaging findings of reversible isolated lesions with transiently reduced diffusion in the splenium of corpus callosum of patients with a wide spectrum of pathological conditions are referred to as reversible splenial lesion syndrome (RESLES). Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is probably included within the spectrum of RESLES; however, its exact pathophysiology is not known. Here, we describe three patients with MERS and one patient with RESLES, all of whom showed elevated urinary β2-microglobulin regardless of diagnosis and presence of pathogens. Elevated urinary β2-microglobulin suggested that an excessive immune response might play a role in the pathophysiology of reversible splenial lesions.

A Patient with Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion in Steroid Responsive Encephalopathy Associated with Autoimmune Thyroiditis

A Patient with Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion in Steroid Responsive Encephalopathy Associated with Autoimmune Thyroiditis

Mild encephalitis/encephalopathy with a reversible splenial lesion caused by Legionnaires’ disease presenting with cerebellar ataxia symptoms and impaired consciousness

Mild encephalitis/encephalopathy with a reversible splenial lesion caused by Legionnaires’ disease presenting with cerebellar ataxia symptoms and impaired consciousness

A Case of Legionella Pneumonia Causing Neurological Symptoms Related to a Reversible Corpus Callosum Lesion

A 51-year-old man presented at the emergency department with a one-day history of fever, altered mental status, slurred speech, worsening gait instability, nausea, vomiting, and diarrhea. The patient did not have a history of alcoholism or drug abuse. On physical examination, crackles were heard over the right lower lobe. Neurological findings revealed ataxic gait, dysarthria and bilateral dysmetria upon finger-nose testing. The results of laboratory tests revealed leukocytosis, renal failure, and hyponatremia. Chest radiography and lung computed tomography (CT) revealed right lower lobe infiltrates with air bronchograms. The result of a urinary Legionella antigen test was positive. The results of brain CT and cerebrospinal fluid (CSF) analyses did not reveal any signs of infection, but brain magnetic resonance imaging (MRI) revealed a corpus callosum lesion upon admission. The patient's symptoms began to resolve after the administration of intravenous levofloxacin. A subsequent brain MRI examination performed 9 days after admission showed the complete resolution of the lesion. He was discharged 11 days after admission without any neurological sequelae. He was finally diagnosed as having clinically mild encephalitis/ encephalopathy with a reversible splenial lesion (MERS).

Mild Encephalitis with a Reversible Splenial Lesion (MERS) Accompanied by Myelitis: A Case Report

Background: Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) can present with various manifestations of central nervous system (CNS) dysfunction. However, MERS with myelitis has rarely been reported. We reported a case of MERS with concomitant myelitis. Case Report: A 35-year-old male was admitted to our department because of decreased mentality. Before admission, he complained of headache, fever over 38.0oC and urinary retention. Brain MRI showed a lesion on the splenium and spine MRI revealed diffuse lesions in the cervicothoracic segments. He was treated with an IV steroid pulse regimen for 5 days. Remarkably, he recovered from his neurological symptoms after 1 month of symptom onset. Conclusion: This is the first report on MERS with concomitant myelitis in Korea. While the etiology is unknown, certain trophisms of infectious pathogens to the CNS structure may have a role in this syndrome. Key Words: Encephalitis; Myelitis; Corpus callosum; Urinary retention; Ataxia of gait

Mild encephalitis with reversible splenial lesion and anti-NMDA receptor encephalitis

Mild encephalitis with reversible splenial lesion and anti-NMDA receptor encephalitis

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) associated with hupoglycemia. Case report and literature review

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) associated with hupoglycemia. Case report and literature review

Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion Associated with Rhinovirus Infection

We report a 7-year-old patient with mild encephalopathy with a reversible splenial lesion (MERS) presenting with recurrent delirious behavior, hallucinations and seizures following common cold.

Abstract O.39: The Incidence Of Abnormal Electroencephalographic Findings And Mild Encephalitis/encephalopathy With A Reversible Splenial Lesion In Kawasaki Disease

Background: Central nervous system inflammation sometimes occurs in Kawasaki disease (KD). In 2012, we reported the first case of KD complicated with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in a 14-year-old. Since then, similar cases have been reported. We studied the incidence of KD complicated with encephalitis/encephalopathy and MERS. Methods: We selected 36 patients (22 boys and 14 girls; age: range, 5-80 months; mean, 22 months) from 42 patients who had undergone electroencephalography (EEG) before intravenous immunoglobulin (IVIG) therapy between May 2013 and August 2014. Patients with and without abnormal EEG findings were assigned to groups A and B, respectively. Age; sex; time of diagnosis; neurological symptoms; N-terminal pro-brain natriuretic peptide, serum procalcitonin, serum sodium, serum albumin, and C-reactive protein (CRP) levels; liver disorder, coronary artery lesion, and IVIG therapy response were examined. Results: Group A comprised 6 patients (17%); and group B, 30 patients (83%). Consciousness disturbance was noted in 5 of 6 patients with abnormal EEG findings, without sequelae. Patients in group A were significantly older (56.5±16.8 vs 25.0±19.9 months ) and had higher CRP levels than those in group B (12.3±5.62 vs 6.56±3.47 mg/dL ). No other parameters showed significant differences. Magnetic resonance imaging revealed edema in 2 of 5 patients and MERS in the remaining patient in group A. Pleocytosis was noted in 1 of 4 patients in group A. Cytokine Il-6 and INF-γ levels were very high in the patient with MERS. Conclusion: EEG findings indicating central nerve disorders were noted in 17% patients, a lower incidence than that reported by Mitudome et al . We performed EEG early before IVIG therapy; thus, central nerve symptoms encountered may have occurred in the early stages of the disorders. MERS was noted in 1 of 6 patients with abnormal EEG findings, or 2 of 9 patients if past cases with neurological symptoms were included, suggesting that central nerve complications occur in a certain group of KD patients.

Reversible Splenial Lesions in Kawasaki Disease in a 7 Year Old Boy- First Reported Case in North America. (P6.248)

Reversible Splenial Lesions in Kawasaki Disease in a 7 Year Old Boy- First Reported Case in North America. (P6.248)

Mild encephalopathy with reversible splenial lesion: An important differential of encephalitis

Mild encephalopathy with a reversible splenial lesion (MERS) is a clinico-radiological syndrome characterized by a transient mild encephalopathy and a reversible lesion in the splenium of the corpus callosum on MRI. This syndrome has almost universally been described in children from Japan and East Asia. Here we describe seven cases of MERS occurring in Caucasian Australian children from one centre seen over a 3 year period. All patients had a fever-associated encephalopathy (n = 7), which presented with confusion (n = 4), irritability (n = 3), lethargy (n = 3), slurred speech (n = 3), drowsiness (n = 2) and hallucinations (n = 2). Other neurological symptoms included ataxia (n = 5) and seizures (n = 1). These symptoms resolved rapidly over 4–6 days followed by complete neurological recovery. In all patients, MRI performed within 1–3 days of onset of encephalopathy demonstrated a symmetrical diffusion-restricted lesion in the splenium of the corpus callosum. Three patients had additional lesions involving other parts of the corpus callosum and adjacent periventricular white matter. These same three patients had mild persisting white matter changes evident at followup MRI, while the other patients had complete resolution of radiological changes. A potential trigger was present in five of the seven cases: Kawasaki disease, Salmonella, cytomegalovirus, influenza B and adenovirus (all n = 1). Elevated white cell count (n = 4), elevated C reactive protein (n = 5) and hyponatremia (n = 6) were commonly observed. CSF was performed in four patients, which showed no pleocytosis. This case series of MERS demonstrates this condition occurs outside of East Asia and is an important differential to consider in children presenting with acute encephalopathy.

Clinicoradiological spectrum of reversible splenial lesion syndrome (RESLES) in adults: a retrospective study of a rare entity.

The presence of reversible lesions that involve the splenium of the corpus callosum (SCC) has been reported in patients with a broad spectrum of diseases and conditions and is referred to as reversible splenial lesion syndrome (RESLES).To describe the clinicoradiological features and establish a clinical position for this disease, we retrospectively examined the clinicoradiological features of adult RESLES patients, as well as discuss the potential pathophysiological mechanisms of this disease.The clinical and MRI findings of patients who presented with RESLES accompanied by symptoms of neurological disorders were retrospectively reviewed. The patients were classified into 2 subgroups (favorable and poor outcome subgroups), which corresponded to the severity of the disability using the Modified Oxford Handicap Scale. In addition, we compared the clinical and neuroimaging features between the 2 outcome subgroups.Eight patients with RESLES associated with various diseases and conditions were included. The clinical presentation was nonspecific; however, MRI exhibited consistent lesions in the SCC with a hypointensity on apparent diffusion coefficient maps and a hyperintensity via diffusion-weighted imaging, which disappeared after a variable lapse. The number of patients with a severe disturbance of consciousness, extracallosal lesions, or diffuse slow waves in the poor outcome subgroup was significantly increased compared with the favorable outcome subgroup (P < 0.05). Thus, the clinicoradiological spectrum of RESLES could be classified into 2 principal categories according to differential outcomes.RESLES is a rare entity with a broad clinicoradiological spectrum because of the various diseases and conditions. Although the overall symptoms of RESLES patients tend to be alleviated, the prognosis of patients with a severe disturbance of consciousness, extracallosal lesions, or diffuse slow waves is likely unfavorable.