Clinical characteristics and outcomes of patients with reversible Splenial lesion syndrome (RESLES)

Amano, Eiichiro; Ishihara, Tasuku; Otsu, Shinichi; Machida, Akira

doi:10.1016/j.jns.2017.08.3701

Cited by 1 publication

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…RESLES is a rare condition with a wide clinical and radiological spectrum occurring in the course of many diseases, metabolic disorders, and other disease states [ 3 , 4 , 5 , 6 , 7 , 12 , 18 ]. In most cases, clinical symptoms tend to improve or even completely resolve; however, in patients with severely disturbed consciousness, the prognosis is unfavorable [ 13 , 14 , 15 , 18 ].…”

Section: Discussingmentioning

confidence: 99%

“…Changes in the splenium are described in many diseases—irreversible or partially reversible—and are related, among others, to isolated corpus callosum infarction (ICCI), head region injuries, congenital malformations (agenesis/dysgenesis of the corpus callosum, lipoma), metabolic disorders (Wilson’s disease, X-linked adrenoleukodystrophy, Krabbe’s disease), and neoplastic tumors (glioblastoma, lymphoma). Transient, reversible changes occur in viral, bacterial, and parasitic infections; during therapy with the use of metronidazole or 5-fluoro-uracil; in the case of toxicity or discontinuation of antiepileptic drug treatment, especially levetiracetam, carbamazepine, and valproates; as well as in states of hypoglycemia, hyper- or hyponatremia, and in high-mountain cerebral edema or in patients with Wernicki’s syndrome [ 2 , 4 , 5 , 6 , 7 ]. The clinical and radiological condition associated with these changes was defined as “reversible splenial lesion syndrome” (RESLES) [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The time of development and disappearance of changes in RESLES varies—in the case of infections, they are most often visible from one day and gradually disappear within 1–2 weeks, while, in the case of the toxic effect of an antiepileptic drug, they may persist for up to three weeks [ 3 , 7 ]. As mentioned, the differentiation should also take into account the edema of the corpus callosum (changes in the form of central rims, abdominal lesions in the splenium, hyperintensive DWI), Wilson’s disease (bilateral, symmetrical morphologically different in the splenium, and also involving the basal nuclei, thalamus, midbrain, bridge, and nucleus), teeth (which, in MRI, present as hyperintensive DWI, FLAIR, without hypointense ADC, white matter edema), X-linked adrenoleukodystrophy (polymorphic lesions including splenium, as well as white matter in the parieto-occipital area, manifesting as hyperintense T2, FLAIR, or FLAIR with variable enhancement of contrast), Krabbe’s disease (globoid cells in the splenium, cortico-spinal tract, and white matter of the parietal lobes, hyperintense axial T2, hypointense sagittal T1, FLAIR, DWI, ADC), glioblastoma multiforme (irregular large mass with infiltration and necrosis, including splenium, supratentorial white creature, hyperintense sagittal T1 and axial T2), B-cell lymphoma (irregular mass along the perivascular spaces, splenium that represents a hyperintensive center and hypointense periphery in the axial FLAIR, isointense T2, iso- or hypointense T1, DWI, ADC), lipoma (often accompanied by agenesis or dysgenesis of the corpus callosum, which, in the MRI image, is manifested by hyperintense T1 with a slight restriction of diffusion in DWI and ADC), post-traumatic changes (morphologically differentiated, asymmetrical with a midline shift, which, in addition to the history, may also be indicated by reduced diffusion of DWI and ADC), and intracranial hypotension (stump-like, downwardly displaced splenium, brain displacement, dilation of veins and sinuses, and its strengthening, isointense in FLAIR) [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…The most common prodromal symptom of RESLES is fever, and the most frequently observed clinical picture is disturbance of consciousness with subsequent full-blown delirium and seizure, which disappear within a month [ 3 , 11 , 12 ]. Other symptoms include headache, disorientation, confusion, hallucinations and other psychotic symptoms, ataxia, dysarthria, disconnection syndrome, and coma [ 6 , 12 , 13 , 14 , 15 ]. Particular attention should be paid to the disconnection syndrome, also known as split-brain syndrome or dyscirculation syndrome, which is known, e.g., as a complication of calosotomy (a neurosurgical procedure involving cutting the corpus callosum, used mainly in severe forms of drug-resistant epilepsy) [ 16 ]; however, it may also be present in RESLES.…”

Section: Introductionmentioning

confidence: 99%

“…Particular attention should be paid to the disconnection syndrome, also known as split-brain syndrome or dyscirculation syndrome, which is known, e.g., as a complication of calosotomy (a neurosurgical procedure involving cutting the corpus callosum, used mainly in severe forms of drug-resistant epilepsy) [ 16 ]; however, it may also be present in RESLES. In its course, the coexistence of several independent consciousnesses in one brain was observed, as well as visual integration disorders (each hemisphere independently perceives the contralateral field of view; however, proper functioning of the corpus callosum is necessary for integration; in the case of disturbance of its functions, the patient is not able to compare two objects when each of them is presented in a different field of vision—right and left), limited reception of stimuli from the non-dominant hemisphere, tactile and/or visual anomy (inability to identify previously known objects, concepts), alien limb syndrome, confusion, hallucinations, psychosis, motor aphasia, mutism, akinesia, and hemiplegia [ 3 , 6 , 12 , 13 , 14 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Reversible Splenial Lesion Syndrome as a Challenging Casuistry

Tatar

Bocian

Świerzy

et al. 2022

IJERPH

View full text Add to dashboard Cite

The corpus callosum plays a vital role in brain function. In particular, in the trunk of the corpus callosum, in the course of various diseases, there may be temporary, reversible changes (reversible splenial lesion syndrome (RESLES)), as well as partially reversible and irreversible changes. This article discusses the differentiation of RESLES and other conditions with changes in the corpus callosum lobe, as well as the accompanying clinical symptoms. Moreover, a case report of a patient in whom the above changes appeared in the nuclear magnetic resonance (NMR) image is presented. A 20-year-old patient with the diagnosis of Ehlers–Danlos syndrome type VI was admitted to the psychiatric ward in an emergency because of psychomotor agitation, refusal to take food and fluids, delusional statements with a message, grandeur, and auditory hallucinations. In the performed magnetic resonance imaging (MRI) of the brain, the corpus callosum non-characteristic in T2-weighted images revealed a hyperintensive area, which was significantly hyperintensive in diffusion magnetic resonance (DWI) sequences and in apparent diffusion coefficient (ADC) sequences with reduced signal intensity and no signs of bleeding. The hypothesis of subacute ischemic stroke of the corpus callosum was presented. In the control MRI of the brain, changes in the corpus callosum completely regressed, thus excluding an ischemic etiology and favoring the diagnosis of RESLES. During hospitalization, the patient experienced significant fluctuations in mental status, with the dominant symptoms typical of the paranoid syndrome in the form of disturbances in the course and structure of thinking and perception, and a clear and stable improvement was obtained after the administration of long-acting intramuscular olanzapine. Taking into account the clinical and radiological picture, the age of the episode, the rapidity of the disease development, the persistence of its clinical symptoms after the withdrawal of radiological changes in the brain NMR image, as well as the significant improvement in the clinical condition after the introduction of antipsychotic drugs, the final diagnosis was made of schizophrenia.

show abstract