MRI findings of a postpartum patient with reversible splenial lesion syndrome (RESLES)

Altunkaş, Ayşegül; Aktaş, Fatma; Özmen, Zafer; Albayrak, Eda; Almus, Ferdağ

doi:10.1007/s13760-015-0578-x

Cited by 5 publications

(7 citation statements)

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“…In their study that focused on the etiology of splenial lesions, Balcik et al [26] reported 5 infection-related cases (3 tuberculosis meningitis and 2 viral encephalitis), where the outcomes of the patients were not stated. There are also a few case reports from our country on the adult population [27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Radiologic and clinical features of infection related cytotoxic lesions of corpus callosum splenium in adults

İkidağ¹

2021

Journal of Surgery and Medicine

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Background/Aim: The cytotoxic lesion of corpus callosum splenium (CLCCS) is a clinical-radiologic syndrome that typically manifests in children. It is characterized by restricted diffusion in the splenium of the corpus callosum on magnetic resonance imaging, and accompanying symptoms of encephalopathy. There are a few case reports regarding the adult population in the literature, and only a couple of these are related to febrile illness in adults. We aimed to evaluate the clinical and the radiologic characteristics of infections related to CLCCS in adults. Methods: For this case series study, we reviewed the MRI examinations that were performed in our hospital between 2014 and 2019 to identify cases with corpus callosum splenium lesions related with febrile diseases in adults. We excluded the cases with demyelinating diseases, trauma, arterial or venous occlusive diseases, metabolic-toxic diseases, and posterior reversible encephalopathy syndrome (PRES), patients who had alcohol or drug abuse, or known malignancies. The admission dates, symptoms within the prodromal period, physical and laboratory findings, electroencephalograms, MRI features, medications and patient outcomes were recorded. Corpus callosum involvement on MRI was classified as Type 1 if lesions were limited to splenium, and Type 2 if pericallosal white matter extension was present. Results: Seven patients (four males, three females, and ages ranging from 18 to 33 years with a mean of 26.4 years) were included in the study. All patients experienced prodromal symptoms such as fever (n=7), nausea (n=5), vomiting (n=4), diarrhea (n=4) and abdominal discomfort (n=3). Neurological symptoms included drowsiness (n=4), speech disorder (n=2), impairment of consciousness (n=4), lower extremity weakness (n=2), and seizures (n=1). Neurological examination revealed confusion (n=4), nuchal rigidity (n=2), and ataxia (n=2). In one patient, the blood culture was positive for Staphylococcus epidermidis, and the stool culture was positive for Enterococcus species. MRI findings of all patients revealed Type 1 oval (n=4) or round (n=3) shaped corpus callosum splenium lesions that appeared hyperintense on T2 and FLAIR images with diffusion restriction. None of our patients had band-like Type 1 or Type 2 lesions. Clinical relief was observed in 2 days in six patients, however, rapid clinical deterioration resulting in death occurred in one patient. Conclusion:The leading symptoms in adults are fever and gastrointestinal disturbances including, nausea, vomiting, and diarrhea, while neurological examinations mostly reveal confusion, nuchal rigidity, and ataxia. In adult patients, restricted diffusion on MRI is usually limited to splenium, and pericallosal white matter is usually not involved. Mostly encountered in autumn and winter, encephalitis/encephalopathy with diffusion restriction in the splenium of corpus callosum in an adult febrile patient usually has a good prognosis, although it may lead to severe outcomes, and even result with death. Clinicians should be aware...

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Section: Discussionmentioning

confidence: 99%

Radiologic and clinical features of infection related cytotoxic lesions of corpus callosum splenium in adults

İkidağ¹

2021

Journal of Surgery and Medicine

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“…11 Signal changes on DWI and ADC indicate that transient cytotoxic edema is the main pathogenesis of RESLES. 12 In the past, several hypotheses have been suggested including intramyelenic or interstitial edema. 8 Recently, some experiments 13,14 have confirmed that there is no significant decrease in the fractional anisotrophy (FA) value in the SCC, which suggests that the integrity of the myelin sheath and the function of the axons in the myelin sheath are almost unaffected.…”

Section: Discussionmentioning

confidence: 99%

Reversible splenial lesion syndrome in children: clinical analysis and summary of a case series

et al. 2020

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“…Important etiological causes of splenial lesions in peripartum cases are sinus vein thrombosis, post-ictal state and preeclapmsia-eclampsia. 15 Takahashi and colleagues reported a rare case of RESLES with postpartum cerebral angiopathy. 16 The predilection for lesions in the SCC is unclear, but it may be related to its relative lack of pressure drop along the vessels, making it susceptible to edema in the setting of hypoxic cerebral vasodilatory circumstances.…”

Section: Discussionmentioning

confidence: 99%

Reversible splenial lesion syndrome (RESLES) coinciding with cerebral venous thrombosis: a report of two cases

Liu

Yang

et al. 2017

Ther Adv Neurol Disord

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A total of two postpartum women with no noteworthy medical history presented with persistent headache. Brain magnetic resonance imaging (MRI) of both revealed extensive cerebral venous thrombosis, concurrently with abnormal signals of the splenium of the corpus callosum (SCC): The splenium appeared hyperintense on T2-weighted sequences, fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI) imaging, and hypointense on T1 sequences and apparent diffusion coefficient (ADC) map. The patients were given thrombolytic therapy. Clinically, both patients achieved recovery with no neurologic sequelae, and follow-up MRI revealed complete resolution of the lesion in the SCC at day 36 and day 37 after initial presentation, respectively.

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MRI findings of a postpartum patient with reversible splenial lesion syndrome (RESLES)

Cited by 5 publications

References 4 publications

Radiologic and clinical features of infection related cytotoxic lesions of corpus callosum splenium in adults

Radiologic and clinical features of infection related cytotoxic lesions of corpus callosum splenium in adults

Reversible splenial lesion syndrome in children: clinical analysis and summary of a case series

Reversible splenial lesion syndrome (RESLES) coinciding with cerebral venous thrombosis: a report of two cases

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