Evaluation of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) by diffusion-weighted and diffusion tensor imaging

Shankar, Balasubramanyam; Narayanan, Ramakrishna; Muralitharan, Pushkaran; Ulaganathan, Balamurugan

doi:10.1136/bcr-2014-204078

Cited by 14 publications

(13 citation statements)

References 2 publications

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“…In recent years, FESCC lesions have been described in a wide variety of conditions. Transient focal splenial edema has also been described in the context of acute encephalopathic syndromes due to a wide variety of causes such as different systemic infections and metabolic alterations, even in the absence of antiseizure medication . It remains unclear whether the focal splenial edema is an epiphenomenon, as most patients are treated empirically with antiviral, antibiotic, and/or steroid medication .…”

Section: Discussionmentioning

confidence: 99%

Rapid discontinuation of sodium channel–blocking antiseizure drugs evokes focal edema in the splenium corporis callosi: A matched case‐control study

et al. 2019

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Objective Focal edema of the splenium of the corpus callosum (FESCC) is infrequently seen in patients with epilepsy who are undergoing video–electroencephalography (EEG) monitoring. It is diagnosed by qualitative visual inspection of the magnetic resonance imaging (MRI) and is usually assumed to be a dichotomous phenomenon. Rapid reduction of anticonvulsants has been proposed as a cause. In this study we investigate the relationship between dose reduction of anticonvulsants and the occurrence of FESCC, based on absolute drug doses. Methods We examined in detail the anticonvulsive therapy of all patients during video‐EEG monitoring between 2014 and 2018. We compared patients with a radiologically diagnosed FESCC to controls in a 1:2 case‐control analysis matched by age, epilepsy syndrome, and adjacent time of admission. In a separate correlation analysis, we examined quantitative effects of reduction of antiseizure drugs on diffusion restriction in the corpus callosum. Results Of 326 patients who had an MRI following video‐EEG monitoring, 12 (3.7%) had FESCC. Antiseizure drugs were reduced to a significantly greater extent in FESCC patients than in the 24 controls (P < 0.001). Sodium channel–blocking antiseizure drugs were reduced (P < 0.001) and reintroduced (P < 0.001) significantly faster in FESCC patients, and the duration of anticonvulsant discontinuation was longer in FESCC patients (P < 0.001). The separate correlation analysis in 325 patients shows a weak correlation between diffusion restriction in the splenium and the reduction rate of sodium channel–blocking anticonvulsants (r = −0.15, P = 0.03) as well as the duration of their discontinuation (r = −0.16, P = 0.01). No such effects were found for anticonvulsants with other modes of action. Significance Our findings substantiate that FESCC is associated with high rates of dose reduction of anticonvulsants, specifically those acting on sodium channels. Our results cautiously suggest that reducing sodium‐channel blockers has a small effect on diffusivity in the splenium below the visual threshold.

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Section: Discussionmentioning

confidence: 99%

Rapid discontinuation of sodium channel–blocking antiseizure drugs evokes focal edema in the splenium corporis callosi: A matched case‐control study

et al. 2019

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“…On follow-up, diffusion restriction completely resolved with normalization of the apparent diffusion coefficient (10). The normal to slightly increased FA values in the lesions may indicate that MERS is a non-degenerative disorder (10). The reversible lesion was present for 5-7 days.…”

Section: Discussionmentioning

confidence: 81%

“…At the time of presentation, the lesions in the splenium of the corpus callosum and bilateral cerebral white matter showed diffusion restriction with reduced apparent diffusion coefficient and no reduction in fractional anisotropy (FA) values on diffusion tensor imaging (10). On follow-up, diffusion restriction completely resolved with normalization of the apparent diffusion coefficient (10). The normal to slightly increased FA values in the lesions may indicate that MERS is a non-degenerative disorder (10).…”

Section: Discussionmentioning

confidence: 85%

“…Shankar et al presented a case of mild encephalitis with a reversible splenial lesion (MERS), evaluated with diffusion-weighted and diffusion tensor imaging along with various conventional sequences of MRI (10). At the time of presentation, the lesions in the splenium of the corpus callosum and bilateral cerebral white matter showed diffusion restriction with reduced apparent diffusion coefficient and no reduction in fractional anisotropy (FA) values on diffusion tensor imaging (10).…”

Section: Discussionmentioning

confidence: 99%

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Encephalitis with Prolonged but Reversible Splenial Lesion

Meleková

Andrlová

Král

et al. 2015

Acta Med. (Hradec Kralove, Czech Repub.)

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Summary:Introduction: The splenium of the corpus callosum has a specific structure of blood supply with a tendency towards blood-brain barrier breakdown, intramyelinic edema, and damage due to hypoxia or toxins. Signs and symptoms of reversible syndrome of the splenium of the corpus callosum typically include disorientation, confusion, impaired consciousness, and epileptic seizures. Case report: A previously healthy 32-year-old man suffered from weakness, headache, and fever. Subsequently, he developed apathy, ataxia, and inability to walk, and therefore was admitted to the hospital. Cerebrospinal fluid showed protein elevation (0.9 g/l) and pleocytosis (232/1 ul). A brain MRI showed hyperintense lesions in the middle of the corpus callosum. The patient was treated with antibiotics, and subsequently, in combination with steroids. Two months later, the hyperintense lesions in the splenium and the basal ganglia had disappeared. Almost seven months since his hospitalization in the Department of Neurology, the patient has returned to his previous employment. He now does not exhibit any mental changes, an optic edema and urological problems have improved. In addition, he is now actively engaged in sports. Conclusion: We have described a case of a 32-year-old man with confusion, ataxia, and inability to stand and walk. The man developed a febrile meningeal syndrome and a hyperintense lesion of the splenium, which lasted for two months. Neurological changes, optic nerve edema, and urinary retention have resolved over the course of seven months. We think that the prolonged but transient lesion of the splenium may have been caused by encephalitis of viral origin.

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“…The lesion is usually oval with clear boundary whereas without obvious edema and space-occupying effect. [51] On MRI, the lesion is homogeneously hypointense signal on T1WI while hyperintense on T2WI and FLAIR. It appeared hyperintense on DWI and showed restricted diffusion on ADC map.…”

Section: Discussionmentioning

confidence: 99%

Reversible splenial lesion syndrome associated with lobar pneumonia

Wu²,

Qi³

et al. 2016

Medicine

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Background:Reversible splenial lesion syndrome (RESLES) is a rare clinico-radiological disorder with unclear pathophysiology. Clinically, RESLES is defined as reversible isolated splenial lesions in the corpus callosum, which can be readily identified by magnetic resonance imaging (MRI) and usually resolve completely over a period of time. RESLES could be typically triggered by infection, antiepileptic drugs (AEDs), poisoning, etc. More factors are increasingly recognized.Methods and results:We reported herein an 18-year-old female patient with lobar pneumonia who developed mental abnormalities during hospitalization. An isolated splenial lesion in the corpus callosum was found by head MRI and the lesion disappeared 15 days later. Based on her clinical manifestations and radiological findings, she was diagnosed with lobar pneumonia associated RESLES. We further summarize the up-to-date knowledge about the etiology, possible pathogenesis, clinical manifestations, radiological features, treatment, and prognosis of RESLES.Conclusion:This report contributes to the clinical understanding of RESLES which may present with mental abnormalities after infection. The characteristic imaging of reversible isolated splenial lesions in the corpus callosum was confirmed in this report. The clinical manifestations and lesions on MRI could disappear naturally after 1 month without special treatment.

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Evaluation of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) by diffusion-weighted and diffusion tensor imaging

Cited by 14 publications

References 2 publications

Rapid discontinuation of sodium channel–blocking antiseizure drugs evokes focal edema in the splenium corporis callosi: A matched case‐control study

Rapid discontinuation of sodium channel–blocking antiseizure drugs evokes focal edema in the splenium corporis callosi: A matched case‐control study

Encephalitis with Prolonged but Reversible Splenial Lesion

Reversible splenial lesion syndrome associated with lobar pneumonia

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