Adult mild encephalitis with reversible splenial lesion and catatonia: A case report

Karoui, M.; Bouhlel, Emna; Maatouk, Ons; Labbène, Emna; Mohamed, Dina Ben; Bouaziz, Mouna Chelli

doi:10.1016/j.heliyon.2022.e10257

Cited by 1 publication

(3 citation statements)

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“…Psychiatric manifestations, although uncommon, have been reported in several MERS cases. 4 , 15 , 16 The pathophysiology of MERS is not fully elucidated but is thought to involve transient cytotoxic edema of the corpus callosum due to inflammation. 6 , 7 , 17 , 18 The corpus callosum, crucial for interhemispheric communication and integration of linguistic and visual information, 19 can be disrupted by lesions, potentially resulting in abnormal language and visuospatial information transmission.…”

Section: Discussionmentioning

confidence: 99%

“…Without the diagnosis of MERS, the patient might have been treated for a schizophrenia spectrum disorder, potentially leading to prolonged psychiatric care and continuous medication due to the risk of relapse or recurrence. Psychiatric manifestations, although uncommon, have been reported in several MERS cases 4,15,16 . The pathophysiology of MERS is not fully elucidated but is thought to involve transient cytotoxic edema of the corpus callosum due to inflammation 6,7,17,18 .…”

Section: Discussionmentioning

confidence: 99%

“… 1 Generally, MERS resolves spontaneously; however, certain etiologies necessitate specific symptomatic treatment. 2 Uniquely, MERS may present with psychiatric symptoms, such as delirium, 2 visual hallucinations, 3 and catatonia, 4 posing diagnostic and treatment challenges. The variability of these neuropsychiatric symptoms necessitates early diagnosis through magnetic resonance imaging (MRI) to avoid prolonged antipsychotic treatment.…”

Section: Introductionmentioning

confidence: 99%

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Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS)

Tsuchida,

Sawada

2024

PCN Reports

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BackgroundMild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is increasingly recognized as a clinicoradiological syndrome. Its etiology is diverse, encompassing a variety of triggers, including infections and metabolic abnormalities. Uniquely, MERS may present with psychiatric symptoms, such as delirium, visual hallucinations, and catatonia, posing diagnostic challenges. The variability of these neuropsychiatric symptoms necessitates early diagnosis through magnetic resonance imaging (MRI) to avoid prolonged antipsychotic treatment.Case PresentationThis report details a case of MERS in a 39‐year‐old male. The patient initially presented with headache, sore throat, and abnormal laboratory results: leukocytosis, neutrophilia with a left shift, elevated C‐reactive protein (CRP) levels, and hyponatremia. On the fourth day of admission, he developed severe anxiety and restlessness, exhibited thoughts of death, and reported experiencing vivid hallucinations upon closing his eyes. MRI revealed a hyperintense lesion in the corpus callosum. A lumbar puncture showed no increase in cell count or protein. The patient showed a positive response to treatment with antibiotics and olanzapine, demonstrating rapid symptomatic improvement. A follow‐up MRI on the 11th day showed complete resolution of the brain lesions. Six months later, no neurological or psychiatric sequelae were noted. The patient's clinical progression and imaging findings led to a definitive diagnosis of MERS.ConclusionThe early presentation of symptoms such as restlessness, hallucinations, and death ideation played a critical role in diagnosing MERS, with early MRI examination being instrumental in both diagnosis and preventing prolonged antipsychotic medication use.

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