ABSTRACT
Objective To discuss the clinical manifestations,imaging features and prognosis of children with mild encephalitis/encephalopathy with a reversible splenial lesion(MERS).Methods Twenty-five patients with MERS admitted to Beijing Children′s Hospital,Capital Medical University,between November 2013 and March 2016 were enrolled and their clinical and imaging data were retrospectively analyzed.Ages of onset of these 25 cases were from 6 months to 13 years old.Because of different clinical manifestations in different onset ages,these 25 cases were divided into 2 groups:≤6 years old group (20 cases),with the onset age of 6 months to 3 years and 9 months old(average 2 years and 2 months);>6 years old group(5 cases),with the onset age of 9 years 3 months to 13 years old (average 10 years and 10 months).Results Nineteen cases among the 25 patients had infection history before onset,including 10 cases of digestive tract infection(all were ≤6 years old children),9 cases of respiratory tract infection(6 children ≤6 years old and 3 children >6 years old).The main clinical manifestations included convulsion (18/25 cases,72.0%),fever (17/25 cases,68.0%),vomiting (11/25 cases,44.0%),and disturbance of consciousness (11/25 cases,44.0%).The main clinical manifestation of ≤6 years old group was convulsion (18/20 cases,90.0%),while the main clinical manifestations of the>6 years old group were fever(3/5 cases,60.0%),headache and dizziness(2/5 cases,40.0%),and none of the patients in >6 years old group had convulsion.Eight cases had liver function injury,myocardial enzymes increased in 10 cases,and hyponatremia occurred in 9 cases.Magnetic resonance imaging (MRI) showed 21 cases were type Ⅰ MERS(only involving corpus callosum),and 4 cases of type Ⅱ MERS which involved corpus callosum as well as deep brain white matter,subcortical white matter (centrum semiovale).MRI lesions disappeared after 8-56 days (average 16.5 days) of anti-infection and reducing intracranial pressure treatment.Conclusion MERS is more common in ≤6 years old children,and digestive tract infection is common in ≤6 years old children,while respiratory tract infection is common in >6 years old children.The symptoms in children are mainly manifested as fever,convulsion,vomiting,conscious disturbance,and so on.Infection and hyponatremia are the main causes of MERS in children.MRI is the first choice of imaging examination methods.
ABSTRACT
Mild encephalitis/ encephalopathy with a reversible splenial lesion (MERS)in the corpus callosum is a clinical - radiological syndrome with typical imaging characteristics,which can be divided into 2 types (MERS Ⅰand MERS Ⅱ)according to the affected parts. The main cause is infection in children. Patients can be presented with symptoms that are common for acute mild encephalitis or encephalopathy such as disturbance of consciousness,hea-dache,vomiting,seizure. Brain magnetic resonance imaging(MRI)indicates lesions in the splenium of the corpus callo-sum. The symptoms and brain MRI lesions disappear almost within 1 month,and the prognosis is usually good. Early recognition is necessary and excessive treatment should be avoided.
ABSTRACT
PURPOSE: The aim of this study was to describe the clinical course and outcome of the patient with epilepsy after acute febrile encephalopathy. METHODS: Medical records of the twenty patients with acute febrile encephalopathy from Mar. 2003 to Dec. 2011, were reviewed. The outcome of epilepsy over 12 months after discharge from encephalopathy was investigated and compared with non-epilepsy group on several clinical and laboratory aspects. RESULTS: All revealed negative on viral study. Eight of 20 patients evolved to epilepsy eventually and 3 out of them had a status epilepticus as initial manifestation. Five of them remained medically intractable. Two showed ongoing violent behavior during follow-up period and 1 had motor weakness of lower limbs for a year. All had non-specific brain MRI findings, except the one who showed suspected cerebritis of right basal ganglia on follow-up study. Five of 8 epilepsy patients showed epileptic discharges on the first electroencephalogram. Two of them showed sustained frontal spikes and one who had abnormal brain MRI findings showed left temporal spike on follow-up EEG. Longer period of altered mentality and more frequent epileptiform discharges on initial EEG appeared to be related with progression to epilepsy during follow-up period. CONCLUSION: Acute febrile encephalopathy in children may be related to poor seizure outcome and resultant psychomotor problems. Further studies including laboratory exams to define its pathophysiology would be needed.
Subject(s)
Child , Humans , Basal Ganglia , Brain , Electroencephalography , Epilepsy , Fever , Follow-Up Studies , Lower Extremity , Medical Records , Seizures , Status EpilepticusABSTRACT
A 59-year-old man visited an emergency room due to the sudden onset of severe dysarthria with a drowsy mental status. MRI demonstrated T2 prolongation and restricted diffusion involving the splenium of the corpus callosum and bilateral frontal white matter neurological signs and symptoms were mild, and the recovery was complete within a week. Follow-up MRI performed one month later revealed complete resolution of the lesions. The clinical and radiological courses were consistent with previously reported reversible isolated splenial lesions in mild encephalitis/encephalopathy except for the presence of frontal lesions. This case suggests that such reversible lesions can occur outside the splenium.
Subject(s)
Humans , Middle Aged , Corpus Callosum , Diffusion , Dysarthria , Emergency Service, Hospital , Follow-Up Studies , Magnetic Resonance ImagingABSTRACT
Higher cortical dysfunction is one of the most important aspects to be considered in pediatric acquired brain injury(ABI)rehabilitation. Recently, higher cortical dysfunction has attracted attention in the medical community and consequently many trials have been carried out, but most of these were only for adults. This review relates the introduction of pediatric ABI rehabilitation therapy in our rehabilitation center. Higher cortical dysfunction treatments in children seem to show better recovery results than treatments in adults because a child's brain has more plasticity. The main etiology of ABI in children is traumatic brain injury(TBI)and acute encephalitis/encephalopathy. The characteristic symptoms are memory disturbance and attention deficit in TBI, and visual problems in acute encephalitis/encephalopathy. It is important for children with higher cortical dysfunction to be enrolled in special education programs and to be cared for under the cooperation of their respective rehabilitation centers, schools and homes.