Transient lesion in the splenium of the corpus callosum due to rotavirus infection

Abstract

Transient signal changes in magnetic resonance imaging (MRI) of the splenium of the corpus callosum (SCC) can result from many different reasons, including encephalitis and encephalopathy caused by infection, seizures, metabolic disorders and asphyxia. We report a case of a 6-year-old Polish girl with rotavirus infection demonstrating a reversible SCC lesion on diffusion-weighted MRI images. She presented six episodes of generalized tonic seizures with mild acute gastroenteritis. Stool test for rotavirus antigen was positive. At the time of admission imaging showed the hyperintense region in T2-weighted and fluid-attenuated inversion-recovery MRI, a well-defined lesion in the splenium of the corpus callosum with restricted diffusion in diffusion-weighted MRI and no enhancement in post contrast T1-weighted imaging. Her first EEG showed slow brain activity in the posterior occipitotemporal portion, consisting mainly of theta waves with a frequency of 4.5–5.5 Hz and amplitude of 40 uV. The lesion had completely disappeared on follow-up MRI 10 days later. The patient recovered fully without any sequelae.

Reversible splenial lesion syndrome in children: Retrospective study and summary of case series

“…Most RV gastroenteritis occurs in children aged 6 months to 2 years, although the mean age of our study was 2.6 years. Similarly, several recent case reports [17][18][19] have also reported RV-infection associated MERS case with respective age of 4 years and 3 months, 4 years and 6 years, implicating that the older children with RV gastroenteritis may have predilection to have MERS. Furthermore, 3 out of 5 RV-infection associated cases in our study had afebrile seizures.…”

Lesions in the Splenium of the Corpus Callosum on MRI in Children: A Review

“…Rotavirus is a major pathogen of gastroenteritis in infants and young children, and is occasionally accompanied by encephalitis/encephalopathy . The pattern of involvement in rotavirus can range from focal to diffuse splenial lesions with or without cerebellitis . In a series of 11 children with rotavirus gastroenteritis and cerebellitis, the gastroenteric symptoms were followed by disturbance of consciousness, mutism, and neurologic sequelae.…”

Benign Convulsions with Mild Gastroenteritis

“…The following two questions remain unanswered [7,8]: (1) are seizures in CwG caused by the direct invasion of viruses into the central nervous system or are they an indirect effect of viruses on the brain with circulating mediates such as cytokines, and (2) why are only infants and young children susceptible to CwG? Rotavirus mainly replicating in the gastrointestinal tracts has been detected in blood, which suggests possibility of the viral spread to the brain [34][35][36][37][38][39]. Rotavirus nonstructural protein 4 (NSP4) that is an important glycosylated protein for viral pathogenicity has been detected in rotavirus-infected neurons [36].…”

“…Rotavirus has been reported in more severe neurologic diseases than CwG: encephalopathy (e.g., mild encephalopathy with a reversible splenial lesion [MERS]), meningoencephalitis and cerebellitis [7,8,38,39]. Norovirus also has been detected in patients with encephalitis/encephalopathy [40].…”