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

Abstract

Objective: To describe clinicoradiological features and outcomes of reversible splenial lesion syndrome (RESLES) in children. Methods: Data from 23 children (25 RESLES episodes; two patients had recurring episodes) was retrospectively reviewed at the

Reversible splenial lesion syndrome in children: a retrospective study of 130 cases

“…In the retrospective study, clinical data of children diagnosed with RESLES in the Department of Neurology of Jiangxi Provincial Children's Hospital from September 2017 to April 2023 were collected. The inclusion criteria for the study were as follows ( 3 , 8 ): (1) children presented with neurological symptoms; (2) MRI showed cytotoxic edema in typical locations (RESLES type-1 limited to the SCC and RESLES type-2 spread to the entire corpus callosum, adjacent white matter, or both); and (3) both the clinical symptoms and imaging findings were reversible. The exclusion criteria for our study were as follows: (1) follow-up was not available; (2) patients with acute disseminated encephalopathy and other common demyelinating disorders involving the corpus callosum, such as acute disseminated encephalomyelitis (ADEM) and neuromyelitis optica spectrum disorders (NMOSD); and (3) patients who were not reviewed for cranial MRI during follow-up.…”

“…Neurological symptoms of RESLES are characterized by seizure, confusion, delirium, abnormal speech, muscle weakness, ophthalmoplegia, facial nerve paralysis, blurred vision, and headache. Affected patients usually recover completely without any sequelae within a month after the onset of neurological symptoms (7)(8)(9). Although RESLES has been reported in patients with a variety of conditions, its definitive pathogenesis remains unclear.…”

Mild Encephalitis/Encephalopathy With Reversible Splenial Lesion Due to Enterococcus faecalis in Children

“… 1 , 2 MERS is a transient encephalopathy associated with a reversible lesion of the splenium of corpus callosum (SCC) on magnetic resonance imaging (MRI) of the brain. 3 , 4 MERS is classified as type 1 when the involvement of SCC is isolated and type 2 when it occurs in association with extensive and/or entire callosal lesions. 1 ,3, 5 MERS is caused by viral infections, including SARS COV-2 (severe acute respiratory syndrome coronavirus-2), 6 bacterial infections, 7 ,8 metabolic disorders, 3 , 5 electrolyte abnormalities, 7 and drugs.…”

“… 10 Molecular mimicry or antibodies induced by antigens with specific affinities for receptors in splenial axons or their myelin sheaths have been suggested to explain the isolated involvement of the splenium. 4 However, no clear data are available in current literature about which antigenic components of Enterococcus faecalis mimic SCC axons. Despite a number of hypotheses, further clinical, radiological, and genetic studies are necessary for a definite conclusion.…”

“…The most common neurological presentation of MERS is delirious behavior, followed by consciousness disturbance and new-onset seizures, all of which completely disappear in about a month. 1 ,3,5, 8 MRI findings show transient splenial lesions with an abnormal signal on DWI-ADC (diffusion-weighted imaging and apparent diffusion coefficient), 4 FLAIR, and T2-WI 2 ; the abnormalities typically do not show enhancement after contrast administration and resolve within 1-2 weeks. 1 ,3,4, 5 …”