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

Tetsuka, Syuichi; Ogawa, Takumi

doi:10.14442/jgfm.17.4_319

Cited by 2 publications

(2 citation statements)

References 9 publications

(24 reference statements)

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“…Indeed, the prognosis for patients with a severe disturbance of consciousness is unfavorable, including death as a probable outcome (Doherty et al, ; Zhang et al, ). In contrast, there have been case reports of patients who presented with only fever or headache and without neurological symptoms (Doherty et al, ; Tetsuka & Ogawa, ; Tsuji, Yoshida, Miyakoshi, & Haruta, ). This variation in clinical symptoms raises the question of whether reversible lesions in the SCC do indeed represent a specific marker for mild encephalitis/encephalopathy.…”

Section: Clinical Spectrum and Manifestationsmentioning

confidence: 99%

“…First, encephalitis/encephalopathy is not always mild but can be severe and isolated reversible lesions in the SCC are not always a good prognostic marker for a benign disease course in patients with MERS. However, in some cases, central nervous system disturbances are absent (Doherty, Jayadev, Watson, Konchada, & Hallam, 2005;Tetsuka & Ogawa, 2016;Zhang, Ma, & Feng, 2015). Second, a reversible lesion in the SCC has been recognized in patients with various diseases and conditions other than viral encephalitis/encephalopathy (Qing et al, 2019;Zhang et al, 2015).…”

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Reversible lesion in the splenium of the corpus callosum

Tetsuka

2019

Brain and Behavior

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107

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Aim of Review The presence of isolated, reversible lesions in the splenium of the corpus callosum (SCC) is essential to confirm the diagnosis of mild encephalitis/encephalopathy. The lesions usually heal within a month after the onset of neurological symptoms. Magnetic resonance imaging (MRI) has increasingly been used as a diagnostic tool, which has led to the publication of an increasing number of case reports. These have highlighted some inconsistencies about encephalitis/encephalopathy. First, the condition is not always mild and may be severe. Second, reversible lesions in the SCC have been identified in various diseases and conditions other than viral encephalitis/encephalopathy. Third, lesions in SCC are not always completely reversible. On this note, this review describes the specific clinical and radiological features of encephalitis/encephalopathy. Findings The reversible lesion in SCC is an MRI finding observable in a wide variety of diseases and conditions. Thus, it should be considered as a secondary change rather than a peculiar feature associated with mild encephalitis/encephalopathy. If reversible lesions are present in the SCC, the symptoms and prognosis are not necessarily favorable, with manifestations of encephalitis/encephalopathy varying from absent to severe. Neuroradiological features that appear as isolated high‐intensity signals on diffusion‐weighted images and a decreased apparent diffusion coefficient of the lesion might indicate a diagnosis of cytotoxic edema. Findings of previous studies suggest that cytokine‐mediated cytotoxic edema of the SCC may be an important pathophysiological manifestation of this condition. Conclusion The reversible lesions in the SCC found on MRI are not exclusive to encephalitis/encephalopathy but may be secondary to other disorders.

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Section: Clinical Spectrum and Manifestationsmentioning

confidence: 99%

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confidence: 99%

Reversible lesion in the splenium of the corpus callosum

Tetsuka

2019

Brain and Behavior

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107

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A case of MERS presenting with acute motor aphasia and tetraparesis and literature review

Şahan,

Yabalak

2024

Egypt J Neurol Psychiatry Neurosurg

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Background Mild encephalopathy wıth reversible splenial lesions (MERS) are a clinical–radiological diagnosis that can be diagnosed with radiological imaging and can be accompanied by impaired consciousness, aphasia, headache, and paralysis. MERS can be divided into two different types based on radiological findings; Involvement of the splenium is seen in type 1, and involvement of the splenium and deep white matter is seen in type 2. MERS Type 2 is very rare in adults. Here, we describe a patient diagnosed with MERS Type 2 and our therapeutic intervention. Case presentation A 22-year-old woman presented with slurred speech, weakness in the extremities and headache that started 14 h ago. The patient had sore throat and fever of 37.6 °C for 2 days, and medical history or family history were unremarkable. Neurological examination revealed that she was conscious, cooperative, with no signs of meningeal irritation. Speech comprehension, naming, and repetition were preserved, motor examination revealed 5/5 left upper extremity strength, 4/5 right upper extremity strength, and 2/5 bilateral lower extremity strength. Diffusion-weighted magnetic resonance imaging (MRI-DWI) revealed bilateral deep white matter and splenium symmetrical diffusion restriction. Blood tests showed high C-reactive protein (CRP) and no leukocytosis. No cells were detected in the cerebrospinal fluid (CSF), protein was 151 mg/dl, glucose was within normal limits. The patient, who developed quadriparesis during follow-up, was started on pulse dose steroids. Neurological examination improved to patient’s baseline at the 12th hour of treatment. In the 72nd hour control MRI-DWI, it was seen that the lesions had regressed. Culture/Polymerase chain reaction (PCR) for bacterial/viral infection agents came back negative. After steroids were given for 5 days, patient was discharged at her baseline. Conclusions MERS is a rare diagnosis in adults and can be radiologically confused with acute toxic leukoencephalopathy. It can be distinguished clinically by the absence of prior infection, fever, and toxic agent exposure. Although there is no consensus in the literature regarding the treatment, the clinical picture improved rapidly after steroid in our case. Despite being rare, it should be considered in the differential diagnosis of patients with deep white matter lesions in adults.

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

Cited by 2 publications

References 9 publications

Reversible lesion in the splenium of the corpus callosum

Reversible lesion in the splenium of the corpus callosum

A case of MERS presenting with acute motor aphasia and tetraparesis and literature review

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