Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion in an Adult Patient with Influenza

Takatsu, H.; Ishimaru, Naoto; Ito, Madoka; Kinami, Saori

doi:10.2169/internalmedicine.8997-17

Cited by 14 publications

(14 citation statements)

References 8 publications

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“…B, body; G, genu; R, rostrum it has become more recognized recently in adults that a reversible lesion in the SCC may no longer be a specific MRI finding in children with mild encephalitis. According to some case reports, MERS could have been triggered by (a) viral infection, including those caused by the influenza virus (Takanashi, Barkovich, Yamaguchi, & Kohno, 2004;Takatsu, Ishimaru, Ito, & Kinami, 2017), rotavirus (Fuchigami et al, 2013), measles virus (Melenotte, Craighero, Girard, Brouqui, & Botelho-Nevers, 2013), adenovirus (Hibino et al, 2014), human parvovirus B19 (Suzuki, Kusaka, & Okada, 2014), and cytomegalovirus (Feraco, Porretti, Marchiò, Bellizzi, & Recla, 2018) and (b) other types of infectious pathogens including Mycoplasma pneumoniae (Yuan et al, 2016), Legionella pneumophila (Tomizawa et al, 2015), Streptococcus pneumoniae (Avcu, Kilinc, Eraslan, Karapinar, & Vardar, 2017), and malaria parasites (Mawatari, Kobayashi, & Yamamoto, 2018).…”

Section: Splenium Of the Corpus Callosum Lesions Demonstrated On Mri Inmentioning

confidence: 99%

Reversible lesion in the splenium of the corpus callosum

Tetsuka

2019

Brain and Behavior

107

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Aim of Review The presence of isolated, reversible lesions in the splenium of the corpus callosum (SCC) is essential to confirm the diagnosis of mild encephalitis/encephalopathy. The lesions usually heal within a month after the onset of neurological symptoms. Magnetic resonance imaging (MRI) has increasingly been used as a diagnostic tool, which has led to the publication of an increasing number of case reports. These have highlighted some inconsistencies about encephalitis/encephalopathy. First, the condition is not always mild and may be severe. Second, reversible lesions in the SCC have been identified in various diseases and conditions other than viral encephalitis/encephalopathy. Third, lesions in SCC are not always completely reversible. On this note, this review describes the specific clinical and radiological features of encephalitis/encephalopathy. Findings The reversible lesion in SCC is an MRI finding observable in a wide variety of diseases and conditions. Thus, it should be considered as a secondary change rather than a peculiar feature associated with mild encephalitis/encephalopathy. If reversible lesions are present in the SCC, the symptoms and prognosis are not necessarily favorable, with manifestations of encephalitis/encephalopathy varying from absent to severe. Neuroradiological features that appear as isolated high‐intensity signals on diffusion‐weighted images and a decreased apparent diffusion coefficient of the lesion might indicate a diagnosis of cytotoxic edema. Findings of previous studies suggest that cytokine‐mediated cytotoxic edema of the SCC may be an important pathophysiological manifestation of this condition. Conclusion The reversible lesions in the SCC found on MRI are not exclusive to encephalitis/encephalopathy but may be secondary to other disorders.

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Section: Splenium Of the Corpus Callosum Lesions Demonstrated On Mri Inmentioning

confidence: 99%

Reversible lesion in the splenium of the corpus callosum

Tetsuka

2019

Brain and Behavior

107

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“…Due to the T2 shine-through effect, hyperintense on DWI without decreased ADC was not realistic. The SCC abnormalities (on T1WI, T2WI, and Flair) of patient #2 and #6 completely disappeared at follow-up MRI (T1WI, T2WI, and Flair), and this could fully demonstrate the reversibility of the lesion [1, 6, 17-19]. Follow-up MRI examination was carried out at 14.67 ± 6.31 days (range 8–25 days) following the initial MRI scanning (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…The most typical MRI finding relates to a restricted but reversible diffusion, which later suggests the full lesion disappearance or its clear reduction in size and/or signal intensity by approximately 2 weeks [4, 5]. MERS may be triggered by (1) viral infection, (2) epilepsy (and the use of antiepileptic drugs), (3) substance withdrawal, (4) metabolic imbalance, (5) drug-related toxicity, (6) cancer, (7) cerebrovascular diseases, and (8) high-altitude disease (altitude sickness) [6-13]. Early symptoms such as fever, cough, vomiting, and/or diarrhea are frequently associated with the evolution of mild encephalopathy.…”

Section: Introductionmentioning

confidence: 99%

Mild Encephalitis/Encephalopathy with a Reversible Isolated Splenial Lesion (MERS) in Adult Patients: A Small Case Series

Zhang

Guo

et al. 2020

Eur Neurol

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Background: Mild encephalitis/encephalopathy with a reversible isolated splenial lesion (MERS) is a rare and complex clinico-radiological condition that aggregates various diseases. From a geographical point of view, most cases have been reported in Asia, especially in Japan. However, a very limited number of studies have properly evaluated Chinese patients diagnosed with MERS. Methods: Putative encephalitis/encephalopathy patients affected by a reversible isolated SCC lesion, as detected by magnetic resonance imaging (MRI), were retrospectively evaluated. Specifically, we reviewed extensive patient data, including prodromal and neurologic symptoms, neurologic examinations, MRI and electroencephalography (EEG) findings, laboratory results, treatments, and prognosis. Results: Six clinically mild encephalitis/encephalopathy patients, affected by a reversible isolated SCC lesion, were identified in a cohort of 22 patients. Six patients presented fever symptoms before the onset of neurological manifestations. Initial MRI data exhibited isolated SCC lesions with isointense or slightly hypointense on T1WI, hyperintense on T2WI, Flair, and DWI, as well as decreased ADC values, without contrast enhancement. EEG data indicated abnormalities (3/4), as well as elevated serum inflammatory markers (5/6) and hyponatremia (4/6). Cell content and protein yields were normal or slightly increased in the CSF of 6 patients, excluding one episode of significant increase in cell number. Patients were treated with corticosteroids, antivirals, and antibiotics, resulting in their full clinical recovery. SCC lesions mostly disappeared in all patients. Conclusion: In our study, the clinical features identified in all affected patients were mostly identical, which consisted of relatively mild CNS manifestations with a promising prognostic status.

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“…Many child-onset MERS cases have been reported in the litarature. However, adult onset MERS is rare [3]. The pathogenesis of MERS is still unknown.…”

mentioning

confidence: 99%

“…The pathogenesis of MERS is still unknown. Several hypotheses have been proposed for pathogenesis of the specific lesion, such as intramyelinic edema, hyponatremia, axonal damage, and oxidative stress [1,3]. High signal intensity on DWI and decreased ADC values of splenium of the corpus callosum have been observed in MERS.…”

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confidence: 99%