Mild Encephalopathy with Reversible Lesions in the Splenium of Corpus Callosum and Bilateral Cerebral Deep white Matter in Identical twins

Abstract

Identical twin brothers developed mild encephalopathy at the age of 7.0 and 9.7 years (Patient 1) and 10.7 years (Patient 2). Patient 1 had influenza A at the time of his second episode, but triggering agents were not evident at the first episode. The triggering agents in Patient 2 were unclear. The neurological features of both patients included transient facial numbness, left arm paresis, dysarthria, and gait disturbance. Diffusion-weighted images from magnetic resonance imaging showed high signal levels at the splenium of corpus callosum and in the bilateral cerebral deep white matter. These results are characteristic of mild encephalitis/encephalopathy with a reversible isolated splenium of corpus callosum lesion. All three episodes were treated with a methylprednisolone pulse. Acyclovir was also administered to Patient 2 and to Patient 1 during his first episode. Patient 1 received an anti-influenza agent and intravenous immunoglobulin during his second episode. Both patients recovered completely without sequelae. Genetic factors, which may predispose identical twins to develop encephalopathy, are discussed.

Butterfly Tumor of the Corpus Callosum: Clinical Characteristics, Diagnosis, and Survival Analysis

“…The intracranial neoplasms involving the bilateral corpus callosum construct a midline configuration in the axial plain which looks like a butterfly in the head. The differential diagnoses in these lesions are infection,[ 13 ] trauma (diffuse axonal injury),[ 14 ] demyelinating disease,[ 15 ] or tumor. [ 3 4 ] Therefore, the majority of butterfly lesions are primary malignant tumors, especially PCNL.…”

Mild encephalopathy with reversible splenial lesion of the corpus callosum - case report

“…Prognóza je obecně příznivá. Většina pacientů má úplné vymizení příznaků během jednoho měsíce bez dlouhodobých neurologických následků (2,3,6). Ovšem u pacientů s lézemi typu II na MR se mohou vyvinout neurologické následky a tyto léze mohou na MR přetrvávat i měsíce (1,5,6).…”

Commentary: Mycoplasma pneumoniae-associated mild encephalitis/encephalopathy with a reversible splenial lesion: Report of two pediatric cases and a comprehensive literature review

“…This may explain why M.pneumoniae infection predominantly occurs in children and suggests that clinical manifestations and extrapulmonary complications of M.pneumoniae infection are caused by immunopathologic response rather than the organism itself Acute disseminated encephalomyelitis caused less prevalent CC involvement in Asian than in American patients 11 . MERS occurred in Japanese twins 12 and sisters 13 . These findings suggest genetic predisposing factor to MERS.…”