Probable etiology of mild encephalopathy with reversible isolated lesions in the corpus callosum in children: A review of 20 cases from northern China

Objective:To explore the etiological spectrum of solitary corpus callosum lesions in children. Methods:Retrospective analysis ofclinical features, laboratory findings and brain MRI of 20 children with isolated corpus callosum lesions and treated in Taiyuan, northern China. Results:The average age of onset was 3.64±3.25 years old. The main clinical symptoms were seizures (13 cases, 65%), fever (10 cases, 50%), gastrointestinal symptoms with vomiting or diarrhea (10 cases, 50%), neck stiffness (5 cases, 25%), altered states of consciousness (4 cases, 20%). Brain MRI showed the splenium lesion to be oval in shape. Repeat MRI showed reversal of the lesion after a mean of 29.5 days. Though the patients were suspected to have probable viral encephalitis, no etiology was found in 15 cases. There was associated gastroenteritis in 5 patients, and rotavirus confirmed in stool in 4 patients. Close to half the patients had hyponatremia. None of the patient had had persistent neurobehavioural symptoms on follow-up at 12-14 months. Conclusions:This study from northern China confirmed that isolated solitary corpus callosum lesion is benign

An unusual presentation of infective endocarditis: Transient encephalopathy with reversible lesions in corpus callosum and white matter

Clinical mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinicradiologicalsyndrome, which has been reported to be associated with many conditions and the mostcommon pathogens are virus. However, bacteria are rare pathogens for MERS. We report a 20-year-oldman diagnosed with definite infective endocarditis, who presented with transient encephalopathy withreversible lesions in the entire corpus callosum and bilateral white matter on magnetic resonance imaging(MRI). The blood culture indicated a Staphylococcus aureus infection. His neurological manifestationimproved and imaging abnormalities faded after receiving a combination of intravenous immunoglobulin,methylprednisolone, and antibiotics. Clinicians should be aware of transient encephalopathy withreversible callosal lesions as a potential unusual presentation of infective endocarditis.

Transient Elevation of Cerebrospinal Fluid Protein in a Patient of Mild Encephalitis with Reversible Lesion in the Splenium: A Case Report

Mild encephalitis with reversible lesion in the splenium (MERS) is a clinicoradiological syndrome presenting as a solitary lesion in the central portion of the splenium of the corpus callosum (SCC) with a radiological finding of restricted diffusion and low apparent diffusion coefficient (ADC) values. Complete resolution of the lesion on follow-up imaging and full clinical recovery are the hallmarks of this syndrome, even with only supportive therapy. MERS is usually associated with normal Cerebrospinal fluid (CSF) findings and an excellent prognosis, even without corticosteroid therapy. Magnetic resonance imaging (MRI) is the ideal modality for initial diagnosis and follow-up. Not many cases of this uncommon clinicoradiological syndrome with transient elevation of CSF proteins have been reported. In the subsequent sections, we present a case report of this unusual clinicoradiological entity with raised CSF protein. We also elaborate on possible differential diagnoses and the syndrome’s proposed pathophysiology.

Mild Encephalopathy with Reversible Lesion in the Splenium of the Corpus Callosum and Bilateral Frontal White Matter

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.