Isolated Reversible Splenial Lesion in Adult Meningitis: A Case Report and Review of the Literature

Tani, Momo; Natori, Shihoko; Noda, Kazuyuki; Fujishima, Kenji; Mizuno, Yoshikuni; Okuma, Yasuyuki

doi:10.2169/internalmedicine.46.6457

Cited by 11 publications

(7 citation statements)

References 10 publications

(4 reference statements)

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“…Isolated and reversible lesion of the SCC has been reported in cases of encephalopathy (MERS) [4,5], antiepileptic drugs (AED), and/or alcohol toxicity [5], metabolic disorders [4,5] such as hypoglycemia, and reversible posterior leukoencephalopathy syndrome [5].…”

Section: Discussionmentioning

confidence: 99%

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A Reversible Lesion of the Corpus Callosum Associated With Bacterial Meningitis

Mimouni¹,

Tazi²,

Miqdadi³

et al. 2022

Cureus

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We report the rare case of a 22-year-old female admitted for headaches, nausea, and an isolated lesion of the splenium of the corpus callosum (SCC) found on brain magnetic resonance imaging (MRI). A lumbar puncture test was performed, and Pseudomonas aeruginosa meningitis was found. Twenty days before the symptoms, she had spinal anesthesia for a cesarean section.As soon as the diagnosis was made, antibiotic therapy was initiated. Nonetheless, no signs or symptoms were related to this lesion, which spontaneously disappeared within one month on the control MRI.Pseudomonas aeruginosa is a gram-negative bacillus and may cause rare and severe meningitis. Therefore, a history of a neurosurgical procedure or spinal anesthesia should be sought in the anamnesis.

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Section: Discussionmentioning

confidence: 99%

“…Isolated and reversible lesions of the splenium of the corpus callosum (SCC) are usually revealed by brain magnetic resonance imaging (MRI) following mild encephalitis, alcohol toxicity, or even hypoglycemia. However, these radiological lesions were described in some patients with meningitis [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

A Reversible Lesion of the Corpus Callosum Associated With Bacterial Meningitis

Mimouni¹,

Tazi²,

Miqdadi³

et al. 2022

Cureus

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“…[29,31] When hyponatremia occurs, the osmotic pressure of the cells in the corpus callosum is decreased and the increased free water entered into the cells leading to cytotoxic edema eventually. [15] Tani et al [96] reviewed clinical date of 24 patients with RESLES and found that all of them had fever, suggesting that fever may be associated with RESLES. The mechanism of fever to result in RESLES may be that fever increased the consumption of brain glucose, thereby reducing local effective osmolarity of brain tissue.…”

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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“…Several viruses (influenza virus, adenovirus, mumps virus, varicella zoster virus [ 2 , 3 ], rotavirus [ 4 ], measles virus [ 5 ], and hepatitis A virus [ 6 ]) and bacteria ( Escherichia coli [ 7 ], Legionella pneumophila [ 8 ], and Mycoplasma pneumoniae [ 9 ]) have been reported to cause MERS, but bacteria are rarely the cause [ 2 , 3 ]. Staphylococcus aureus , especially, is a very rare cause of MERS, and only one such case has been reported so far [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion caused by methicillin-sensitive Staphylococcus aureus bacteremia with toxic shock syndrome: a case report

et al. 2016

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BackgroundClinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a mild encephalopathy caused by various pathological processes, but encephalopathy due to bacteria is rare.Case presentationWe report the case of a 45-year-old Japanese woman who on receiving chemotherapy for advanced breast cancer developed an altered mental status and dysarthria soon after fever from infection of a subcutaneous implantable port. Staphylococcus aureus was detected in her blood cultures. Magnetic resonance imaging (MRI) revealed an ovoid lesion in the central portion of the splenium of the corpus callosum (SCC). Although hypotension was not observed, we diagnosed probable toxic shock syndrome (TSS) based on fever (temperature: >38.9 °C), altered mental status, erythema, desquamation, thrombocytopenia, liver dysfunction, and creatine phosphokinase elevation. We administered antimicrobial therapy and her neurological symptoms improved gradually. The lesion in the SCC completely disappeared on MRI 7 days after disease onset.ConclusionsWe diagnosed this case as MERS caused by S. aureus bacteremia with TSS. This is the first report of such a case, and we suggest that when a TSS patient presents with neurological symptoms, the possibility of MERS should be considered.

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Isolated Reversible Splenial Lesion in Adult Meningitis: A Case Report and Review of the Literature

Cited by 11 publications

References 10 publications

A Reversible Lesion of the Corpus Callosum Associated With Bacterial Meningitis

A Reversible Lesion of the Corpus Callosum Associated With Bacterial Meningitis

Reversible splenial lesion syndrome associated with lobar pneumonia

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion caused by methicillin-sensitive Staphylococcus aureus bacteremia with toxic shock syndrome: a case report

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