A reversible lesion of the corpus callosum splenium with adult influenza-associated encephalitis/encephalopathy: a case report

Abstract

IntroductionInfluenza virus-associated encephalitis/encephalopathy is a severe childhood illness with a poor prognosis. Adult case reports are rare and, to date, there have been no reports of adults with a mild subcortical encephalopathy with reversible lesions of the corpus callosum splenium.Case presentationA previously healthy 35-year-old man presented with acute progressive tetraplegia, transcortical motor aphasia and a mild decrease in his consciousness during his recovery after receiving oseltamivir phosphate treatment, and influenza type A antiviral medication. The initial magnetic resonance imaging study at day 1 showed symmetrical diffuse lesions in the white matter and a lesion on the central portion of the corpus callosum splenium. These findings had resolved on follow-up studies at day 8 and day 146. His neurological deficits mostly recovered within 12 hours following methylprednisolone pulse therapy. The levels of interleukin-6 and interleukin-10 in his blood and cerebrospinal fluid were initially elevated, but rapidly decreased to normal levels by day 8.ConclusionIt is important for clinicians to recognize that even in adulthood, the subcortical encephalopathy observed during the therapeutic treatment for influenza type A infection can occur in conjunction with a reversible lesion of the corpus callosum, which may recover quickly. In addition, the cytokine storm in the blood system and the corticospinal cavity may play an important role in the etiology of the disease process.

Transient Splenial Lesion of the Corpus Callosum in H1N1 Influenza Virus-Associated Encephalitis/Encephalopathy

“…Furthermore, a similar transient splenial lesion of the corpus collosum on MRI has been also demonstrated in both child and adult patients with seasonal influenza complicated by encephalitis/encephalopathy (7)(8)(9). These characteristic MRI findings were only found in clinically mild cases (10), and they were correlated with the minimal to absent pleocytosis in cerebrospinal fluid just like the present case.…”

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

“…The next day, he had an acute progressive tetraplegia and transcortical motor aphasia with mildly altered mental status. 4 However, our patient did not present with neurological signs.…”

“…3 It has also been reported in some cases of mild encephalitis/encephalopathy caused by various agents, such as influenza, mumps, rotavirus, adenovirus, human herpesvirus-6, measles virus, Escherichia coli, streptococcus, Salmonella enteritidis, Legionella, Hyponatremia, antiepileptic drug, and acute urinary retention. [1][2][3][4][5][6][7] To our knowledge, this is the first report of a patient with MERS detected on a brain MRI who did not present with any central nervous system disturbances.…”

“…Therefore, by aggressive and early steroid pulse therapy for the disease, our patient may have not presented central nervous system neurological signs. 4 SCC is considered to be between 1 and 3 days after the prodromal symptoms, and that abnormal lesion disappears within a week. 6 MRI splenial lesions may be a good prognostic radiological marker for patients with encephalitis/encephalopathy.…”

Tumefactive acute disseminated encephalomyelitis complicating human swine influenza (H1N1)

“…A few were also reported in adults, [2][3][4] but in them the presentations were not as florid and radiologically severe. We report this case of a 21-year-old, ambulatory and independent woman, with a history of cerebral palsy and epilepsy.…”