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Objective To explore the clinical characteristics of rotavirus associated mild encephalopathy/encephalitis with reversible splenial lesion(RAMERS).Methods RAMERS cases were collected from December 2017 to January 2018 at the Department of Neurology,Jiangxi Children's Hospital.The clinical and electroencephalogram characteristics of 14 patients with RAMERS were retrospectively investigated.Data was analyzed by using SPSS 19.0 software.Results Fourteen cases of RAMERS were tested,9 males,and 5 females,with the average age of (27.00 ±6.45) months,and all cases suffered from the generalized tonic-clonic seizures,57.14％ (8/14 cases) had cluster seizure (at lest 2 times/day),convulsions occurred (3.14 ± 1.29) days after gastroenteritis,and 64.29％ (9/14 cases) had pathologic fever (38 ℃ or higher).The background of electroencephalogram(EEG) was characterized by nonspecific rhythmic slow waves in 10 cases (71.43 ％,10/14 cases),normal in 3 cases (21.43 ％,3/14 cases),and interictal EEG performed in 1 case(7.14％,1/14 cases) which was characterized by focal discharges of spikes in the forehead,central,and all of the EEG manifestations go back to normal after 2 weeks.Twelve patients' brain MRI showed solitary splenium of corpus callosum lesion,and two showed splenium of corpus callosum and bilateral symmetry white matter lesion.Conclusions RAMERS is a special type of reversible splenial lesion syndrome,which occurs predominantly in infants and young children.It is characterized by gastroenteritis,benign infantile convulsion,cluster seizure and nonspecific rhythmic slow waves in the background of EEG.Prognosis is usually excellent.Head MRI reexamination is not recommended as a routine procedure to avoid overtreatment.
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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.
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Objective To explore the MRI diagnosis characteristics of reversible splenial lesion syndrome (RESLES).Methods The clinical and imaging data of 12 cases of RESLES was analyzed retrospectively.MRI plain scan and DWI of brain were performed in all the cases.Apparent diffusion coefficient (ADC) value was obtained through post-processing function.Results 8 of 12 cases were children and 4 were adults.The splenium of corpus callosum of 12 cases showed round lesions,with slightly long T1 and slightly long T2 signal on MRI,high signal on DWI,and low signal on ADC map.The mean value of ADC of 12 cases was about 0.43× 10-3 mm2/s.The MRI reexamination was made after treatment in 12 cases,which showed the lesion of splenium of corpus callosum disappeared,and clinical syndromes were improved.Conclusion The MRI manifestation of RESLES is characterized by solitary lesion.The ADC value could accurately reflect the molecular diffusion information of the lesion.
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BACKGROUND: An infection known to be a major cause of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). Rapidly progressive dementia is a neurological condition in which dementia progresses in a short period of time. CASE REPORT: We report on a 78-year-old woman presenting with a rapid decline in cognitive function resulting from a scrub typhus infection. Diffusion weighted images showed a signal intensity at the splenium, and subcortical white matter of both hemispheres suggesting MERS. On the neuropsychological test, the patient showed frontal executive dysfunction. CONCLUSIONS: This case suggests that diagnosticians should consider the possibility that a MERS patient with a rapidly cognitive decline could have a scrub typhus infection because early diagnosis of scrub typhus is very important in this aspect of the treatment.
Subject(s)
Aged , Female , Humans , Brain Diseases , Cognition , Dementia , Diffusion , Early Diagnosis , Neuropsychological Tests , Scrub Typhus , White MatterABSTRACT
Mild encephalopathy/encephalitis with a reversible spleniat (MERS) lesion is a clinic-radiological entity.The clinical features of MERS in neonates are still not systemically reported.This paper presents five cases of MERS,and the up-to-date reviews of previously reported cases were collected and analyzed in the literature.Here we describe five cases clinically diagnosed with MERS.All of them were neonates and the average age was about 4 days.They were admitted for the common neurological symptoms such as hyperspasmia,poor reactivity and delirium.Auxiliary examinations during hospitalization also exhibited features in common.In this report,we reached following conclusions.Firstly,magnetic resonance imaging revealed solitary or comprehensive lesions in the splenium of corpus callosum,some of them extending to almost the whole corpus callosum.The lesions showed low intensity signal on Tl-weighted images,homogeneously hyperintense signal on T2-weighted images,fluid-attenuated inversion recovery and diffusion-weighted images,and exhibited an obvious reduced diffusion on apparent diffusion coefficient map.Moreover,the lesions in the magnetic resonance imaging disappeared very quickly even prior to the clinical recovery.Secondly,all the cases depicted here suffered electrolyte disturbances especially hyponatremia which could be easily corrected.Lastly,all of the cases recovered quickly over one week to one month and majority of them exhibited signs of infections and normal electroencephalography.
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The clinical data and imaging findings of 10 patients with reversible splenial lesion syndrome ( RESLES ) admitted in Shanxi people′s Hospital from August 2014 to August 2016 were retrospectively analyzed .All 10 patients were acute or subacute onset , the etiology included viral meningitis ( n =5 ) , purulent meningitis ( n =2 ) , tuberculous meningitis ( n =1 ); and one schizophrenic patient receiving antipsychotic drug and one epileptic patient treated with phenytoin .There were 8 patients under 30 years.The clinical manifestations included headache , fever, disorder of consciousness and mental symptoms.Seven patients had prodromic infections before the onset of the disease and focal neurological defects were present in the early stage .The initial MRI showed isolated splenium of corpus callosum (SCC) lesions with homogeneous hyperintense on T 2WI, hypointense on T1WI, and patchy, round, ovoid, schistose diffusion with hyperintense on DWI in all 10 cases;and there was no significant strengthening on enhanced MRI in 4 cases.The follow-up MRI showed that SCC abnormalities disappeared after treatment in 9 cases and the neurological symptoms disappeared after one-month follow up in 6 cases.The results indicate that RESLES is frequently secondary to infections , and presents the symptoms of mild encephalitis or encephalopathy .
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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.
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Reversible splenial lesion syndrome can be caused by viral infection. Rubella generally occurs in childhood, and it is rarely accompanied by neurological complications in adulthood. A 35-year-old man visited our hospital due to conjunctival injection, mild fever, and headache 3 days after experiencing skin rash. Brain magnetic resonance imaging (MRI) revealed distinct lesions involving white matter in the splenium of the corpus callosum approximately 3 days following the onset of symptoms. Enzyme immunoassay performed on serum and CSF samples was positive for rubella virus IgM. A follow-up brain MRI was performed 24 days after the onset of symptoms, and reduced lesion size with decreased signals were observed on diffusion weighted image. This case showed that rubella infection can result in reversible splenial lesion accompanied by only mild neurological symptoms.
Subject(s)
RubellaABSTRACT
Objective To investigate the clinical and MRI characteristics of reversible splenial lesion syndrome (RESLES).Methods The clinical data,MRI features and follow-up results of 18 patients with RESLES were analyzed retrospectively.Results The average age of the patients was younger,and 5 cases were below 1 5 years old.Clinical history and MRI features were characterized.About 67%(12/18)patients had fever,headache,encephalitis,history,without long history of alcohol abuse.MRI revealed that the lesions of splenial of corpus callosum were solitary nodule with clear boundary.The lesions were slightly hyperintensity on T2 WI and obviouslyhyperintensity on FLAIR and DWI,while the they show hypointensity on ADC with the ADC value <1×10-3 mm2/s.No edema or significant enhancement were observed.The lesions may completely disappear or relief on DWI after short treatment.Conclusion RESLES is a rare entity with a broad clinicoradiological spectrum.The MRI features are characteristic,and it will provide helpful information for diagnosis, differential diagnosis and clinical treatment.
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Objective To investigate the diagnostic value of MRI in reversible splenial lesion syndrome (RESLES) in children.Methods The clinical and MRI imaging data of 14 cases of RESLES in children were retrospectively reviewed.There were 4 males and 10 females,aging 11 to 35 months.Average age was (20±3) months.MRI studies were conducted in all the cases.Two experienced doctors analyzed independently the images and reached consensus.Results Fourteen cases showed the single abnormal signal in the splenial of corpus callosum on the initial cerebral MRI.Lesions in 10 of 14 cases appeared as isointensity on T1WI,hypo-intensity in 4 cases.Lesions in 14 cases were appeared as hyper-intensity on T2WI,hyper-/slightly hyper-intensity on FLAIR T2WI.The lesions were round,oval or irregular,with fuzzy boundary.DWI showed round or oval high signal with clear boundary.No edema around the lesion and no occupying effect were detected.After treatment,8 of 14 cases were reviewed after 7-14 d,and the abnormal signal in the corpus callosum disappeared in 5 cases,while the range was significantly reduced in 3 cases.MRI were reexamined after 1-2 months in 5 cases,and the lesions disappeared in the corpus callosum.One case didn't have MRI examination again after treatment and the clinical symptoms disappeared.Conclusions The clinical manifestations of RESLES in children are lack of specificity.And the cerebral MRI imaging is characterized by the reversible solitary lesion of the splenium,which can provide a reliable basis for clinical diagnosis and prognosis.
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Objective To describe the clinical and radiological characteristics, the etiology, clinical course and MRI findings and prognosis of reversible splenial lesion syndrome ( RESLES) are analyzed.Methods Clinical and MRI findings of adult patients who presented with RESLES were retrospectively reviewed.Corresponding to severity of disability using Modified Oxford Handicap Scale ( MOHS ) , patients were classified into favorable outcome group (MOHS≤2)and poor outcome group(MOHS≥3),clinical and neuroimaging features between two outcome groups were compared.Results Eight patients fulfilled the criteria were included, who suffered from a broad spectrum of disorders, including mild encephalitis/encephalopathy, Marchiafava-Bignami disease and antiepileptic drug withdrawal.MRI found a high signal lesion in the splenium with or without the other parts of corpus callosum and extracallosal involved.The hyperintensity disappeared or lapsed comfirmed by repeated MRI.There is an significant difference on symptoms of severe disturbance of consciousness during clinical course and MRI showed extracallosal lesions between two groups (P<0.05).Conclusions RESLES is a rare entity with wide clinicoradiological spectrum due to varied diseases and conditions.Although overall symptoms of patients with RESLES trend to relieve, the prognosis of patients with severe disturbance of consciousness and extracallosal lesions are unlikely to be favorable.
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Reversible splenial edema has been often reported in epilepsy patients. Clinical presentation is reported to be silent in general. We experienced a patient with splenial lesion and cognitive dysfunction. A 21-year-old man underwent video-EEG monitoring for preoperative evaluation. He had suffered from viral encephalitis eight years ago and developed chronic drug-resistant epilepsy. After antiepileptic drugs withdrawal, he developed eight episodes of secondarily generalized tonic-clonic seizures for several hours and some seizures were repeated without recovery of consciousness. Majority of ictal EEG onset presumed to originate from the left frontal region. After seizures he had shown disorientation and irritability with gradual recovery. Brain MRI demonstrated a splenial lesion. Though splenial lesion disappeared on follow-up MRI, neuropsychological test demonstrated frontal lobe dysfunction 6 months later compared with that performed just before the video-EEG monitoring. We report a patient with isolated reversible splenial lesion associated with long term dysfunction of frontal lobe.