Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in a patient presenting with papilledema

Değirmenci, Eylem; Değirmenci, Taner; Çetin, Ebru; Kıroğlu, Yılmaz

doi:10.1007/s13760-014-0314-y

Cited by 7 publications

(5 citation statements)

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“…The neurological symptoms of RESLES associated with encephalitis/encephalopathy can presented with delirious behavior, short disturbance of consciousness, and seizures, but usually had complete recovery without neurological sequelae after a short disease course [ 9 – 11 ]. Therefore at sometimes, RESLES associated with encephalitis/encephalopathy was interchangeably termed as clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Reversible splenial lesion syndrome associated with encephalitis/encephalopathy presenting with great clinical heterogeneity

et al. 2016

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BackgroundReversible splenial lesion syndrome (RESLES) is a disorder radiologically characterized by reversible lesion in the splenium of the corpus callosum (SCC). Most of patients with RESLES associated with encephalitis/encephalopathy were identified in Japanese population, but almost no Chinese patients were diagnosed as RESLES associated with encephalitis/encephalopathy.MethodsPossible patients with reversible isolated SCC lesions were retrieved from January 2012 to July 2015 using keyword “restricted diffusion and isolated SCC lesion” in MRI report system from a large academic center. The clinical, laboratory and radiological data were summarized.ResultsA total of 15 encephalitis/encephalopathy patients (9 males and 6 females) were identified with a reversible isolated SCC lesion. Except for 13 patients with fever symptom, 8 patients also had cold symptoms before the onset of neurological symptoms. The neurological symptoms included headache, vertigo, seizure, disturbance of consciousness, and delirious behavior. Thirteen patients completely recovered within 1 month, but 2 patients who were subjected to mechanical ventilation had persistent neurological deficits. The initial MRI features showed isolated ovoid or extending SCC lesions with homogeneous hyperintense on diffusion weighted imaging (DWI) and decreased apparent diffusion coefficient (ADC) values. The follow-up MRI revealed that isolated SCC lesions with diffuse restriction disappeared at 10 to 32 days after the initial MRI study. Fractional anisotropy map revealed the decreased value of SCC lesion in a severe case with poor prognosis.ConclusionsRESLES associated with encephalitis/encephalopathy is a reversible syndrome with an excellent prognosis in most patients, while a few patients required ventilator supporting at the early stage might have severe neurological sequelae. Reversible signal changes on DWI and ADC are identified in all patients, but fractional anisotropy values can be decreased in severe patient with neurological sequelae.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-016-0572-9) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Reversible splenial lesion syndrome associated with encephalitis/encephalopathy presenting with great clinical heterogeneity

et al. 2016

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“…Transient splenial lesions of the corpus callosum are described in association with many diverse clinical conditions including various infections, use or withdrawal of antiepileptic drugs, and hypoglycemia (1)(2)(3)(4)(5)(6). The lesion appears as a well-defined hyperintense ovoid lesion in the center of the splenium of the corpus callosum, best observed in diffusion weighted brain magnetic resonance images.…”

Section: Introductionmentioning

confidence: 99%

Transient Splenial Lesion of the Corpus Callosum Related to Migraine with Aura in a Pediatric Patient

Ünver

Kutlubay

Besci

et al. 2016

Acta Med. (Hradec Kralove, Czech Repub.)

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“…Its development is attributed to antiepileptic drugs, alcohol abuse, hypernatremia, altitude sickness, radiation therapy, various toxic exposures, and infectious agents (2,3). The etiology of MERS is infectious (1,12), which was present also in our patient.…”

Section: Discussionmentioning

confidence: 58%

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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Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in a patient presenting with papilledema

Cited by 7 publications

References 5 publications

Reversible splenial lesion syndrome associated with encephalitis/encephalopathy presenting with great clinical heterogeneity

Reversible splenial lesion syndrome associated with encephalitis/encephalopathy presenting with great clinical heterogeneity

Transient Splenial Lesion of the Corpus Callosum Related to Migraine with Aura in a Pediatric Patient

Encephalitis with Prolonged but Reversible Splenial Lesion

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