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Abstract
We report the case of a 15-year-old boy with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). He presented with diplopia and ataxia and his cerebrospinal fluid showed mild pleocytosis and elevated protein. MRI demonstrated a reversible splenial lesion in the corpus callosum. He did not receive any treatment and recovered quickly within two weeks. Results of neurological examination after 3 months were completely normal. MERS is relatively unknown in Europe. The majority of patients are reported in East Asia. This post-infectious encephalitis/encephalopathy arises soon after the onset of symptoms. The prognosis is excellent and most patients recover completely without neurological sequelae. MRI typically shows a reversible splenial lesion with diffusion restriction and without contrast enhancement, sometimes with adjacent symmetrical lesions extending into the subcortical white matter. The pathogenesis is still unknown. Recognition of the condition and its clinic-radiological discrimination from acute disseminated encephalomyelitis may prevent unnecessary treatment.
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Copyright (c) 2019 Erim van Os, Malou Nijhuis, Stephan Malm
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References
- Kobata R, Tsukahara H, Nakai A, Tanizawa A, Ishimori Y, Kawamura Y, et al. Transient MR signal changes in the splenium of the corpus callosum in rotavirus encephalopathy: value of diffusion-weighted imaging. J Comput Assist Tomogr. 2002;26:825–8
- Matsubara K, Kodera M, Nigami H, Yura K, Fukaya T. Reversible splenial lesion in influenza virus encephalopathy. Pediatr Neurol. 2007;37:431–4
- Ka A, Britton P, Troedson C, Webster R, Procopis P, et al. Mild encephalopathy with reversible splenial lesion: an important differential of encephalitis. Eur J Paediatr Neurol. 2015;19:377–382
- Takanashi J. Two newly proposed infectious encephalitis/encephalopathy syndromes. Brain Dev. 2009;31:521–8
- Notebaert A, Willems J, Coucke L, Van Coster R, Verhelst H. Expanding the spectrum of MERS type 2 lesions, a particular form of encephalitis. Pediatr Neurol. 2013;48:135–8
- Tada H, Takanashi J, Barkovich AJ, Oba H, Maeda M, Tsukahara H, et al. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion. Neurology. 2004;63:1854–8
- Liptai Z, Ivády B, Barsi P, Várallyay G, Rudas G, Fogarasi A. Mild encephalitis/encephalopathy with a reversible splenial lesion in children. Ideggyogy Sz. 2013;66:67–71
- Ganapathy S, Ey EH, Wolfson BJ, Khan N. Transient isolated lesion of the splenium associated with clinically mild influenza encephalitis. Pediatr Radiol. 2008;38:1243–5
- Fluss J, Ferey S, Menache-Starobinski C, Delavelle J, Van Bogaert P, Vargas MI. Mild influenza-associated encephalopathy/encephalitis with a reversible splenial lesion in a Caucasian child with additional cerebellar features. Eur J Paediatr Neurol. 2010;14:97–100
- Abenhaim Halpern L, Agyeman P, Steinlin M, El-Koussy M, Grunt S. Mild encephalopathy with splenial lesion and parainfluenza virus infection. Pediatr Neurol. 2013;48:252–4
- Mazur-Melewska K, Jonczyk-Ptoczna K, Szpura K, Biegański G, Mania A, Kemnitz P, et al. Transient lesion in the splenium of the corpus callosum due to rotavirus infection. Childs Nerv Syst. 2015;31:997–1000
- Shah S, Keil A, Gara K, Nagarajan, L. Neurologic complications of influenza. J Child Neurol. 2014;29:NP49–NP53
- Kato Z, Kozawa R, Hashimoto K, Kondo N. Transient lesion in the splenium of the corpus callosum in acute cerebellitis. J Child Neurol. 2003;18:291–2
- Hashimoto Y, Takanashi J, Kaiho K, Fujii K, Okubo T, Ota S, Kohno Y. A splenial lesion with transiently reduced diffusion in clinically mild encephalitis is not always reversible. A case report. Brain Dev. 2009;31:710–2
- Takanashi J, Imamura A, Hayakawa F, Terada H. Differences in the time course of splenial and white matter lesions in clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). J Neurol Sci. 2010;292:24–7
- Takanashi J, Barkovich AJ, Shiihara T, Tada H, Kawatani M, Tsukahara H, et al. Widening spectrum of a reversible splenial lesion with transiently reduced diffusion. AJNR Am J Neuroradiol. 2006;27:836–8
- Takanashi J, Barkovich AJ, Yamaguchi K, Kohno Y. Influenza-associated encephalitis/encephalopathy with a reversible lesion in the splenium of the corpus callosum: a case report and literature review. AJNR Am J Neuroradiol. 2004;25:798–802
- Takanashi J, Tada H, Maeda M, Suzuki M, Terada H, Barkovich AJ. Encephalopathy with a reversible splenial lesion is associated with hyponatremia. Brain Dev. 2009;31:217–20
- Bulakbasi N, Kocaoglu M, Tayfun C, Ucoz T. Transient splenial lesion of the corpus callosum in clinically mild influenza-associated encephalitis/encephalopathy. AJNR Am J Neuroradiol. 2006;27:1983–6
- Matas SL, Von Glehn F, Fernandes GB, Soares CA. Cerebrospinal fluid analysis in the context of CNS demyelinating diseases. Arq Neuropsiquiatr. 2013;71:685–8
- Fukuda S, Kishi K, Yasuda K, Sejima H, Yamaguchi S. Rotavirus-associated encephalopathy with a reversible splenial lesion. Pediatr Neurol. 2009;40:131–3
References
Kobata R, Tsukahara H, Nakai A, Tanizawa A, Ishimori Y, Kawamura Y, et al. Transient MR signal changes in the splenium of the corpus callosum in rotavirus encephalopathy: value of diffusion-weighted imaging. J Comput Assist Tomogr. 2002;26:825–8
Matsubara K, Kodera M, Nigami H, Yura K, Fukaya T. Reversible splenial lesion in influenza virus encephalopathy. Pediatr Neurol. 2007;37:431–4
Ka A, Britton P, Troedson C, Webster R, Procopis P, et al. Mild encephalopathy with reversible splenial lesion: an important differential of encephalitis. Eur J Paediatr Neurol. 2015;19:377–382
Takanashi J. Two newly proposed infectious encephalitis/encephalopathy syndromes. Brain Dev. 2009;31:521–8
Notebaert A, Willems J, Coucke L, Van Coster R, Verhelst H. Expanding the spectrum of MERS type 2 lesions, a particular form of encephalitis. Pediatr Neurol. 2013;48:135–8
Tada H, Takanashi J, Barkovich AJ, Oba H, Maeda M, Tsukahara H, et al. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion. Neurology. 2004;63:1854–8
Liptai Z, Ivády B, Barsi P, Várallyay G, Rudas G, Fogarasi A. Mild encephalitis/encephalopathy with a reversible splenial lesion in children. Ideggyogy Sz. 2013;66:67–71
Ganapathy S, Ey EH, Wolfson BJ, Khan N. Transient isolated lesion of the splenium associated with clinically mild influenza encephalitis. Pediatr Radiol. 2008;38:1243–5
Fluss J, Ferey S, Menache-Starobinski C, Delavelle J, Van Bogaert P, Vargas MI. Mild influenza-associated encephalopathy/encephalitis with a reversible splenial lesion in a Caucasian child with additional cerebellar features. Eur J Paediatr Neurol. 2010;14:97–100
Abenhaim Halpern L, Agyeman P, Steinlin M, El-Koussy M, Grunt S. Mild encephalopathy with splenial lesion and parainfluenza virus infection. Pediatr Neurol. 2013;48:252–4
Mazur-Melewska K, Jonczyk-Ptoczna K, Szpura K, Biegański G, Mania A, Kemnitz P, et al. Transient lesion in the splenium of the corpus callosum due to rotavirus infection. Childs Nerv Syst. 2015;31:997–1000
Shah S, Keil A, Gara K, Nagarajan, L. Neurologic complications of influenza. J Child Neurol. 2014;29:NP49–NP53
Kato Z, Kozawa R, Hashimoto K, Kondo N. Transient lesion in the splenium of the corpus callosum in acute cerebellitis. J Child Neurol. 2003;18:291–2
Hashimoto Y, Takanashi J, Kaiho K, Fujii K, Okubo T, Ota S, Kohno Y. A splenial lesion with transiently reduced diffusion in clinically mild encephalitis is not always reversible. A case report. Brain Dev. 2009;31:710–2
Takanashi J, Imamura A, Hayakawa F, Terada H. Differences in the time course of splenial and white matter lesions in clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). J Neurol Sci. 2010;292:24–7
Takanashi J, Barkovich AJ, Shiihara T, Tada H, Kawatani M, Tsukahara H, et al. Widening spectrum of a reversible splenial lesion with transiently reduced diffusion. AJNR Am J Neuroradiol. 2006;27:836–8
Takanashi J, Barkovich AJ, Yamaguchi K, Kohno Y. Influenza-associated encephalitis/encephalopathy with a reversible lesion in the splenium of the corpus callosum: a case report and literature review. AJNR Am J Neuroradiol. 2004;25:798–802
Takanashi J, Tada H, Maeda M, Suzuki M, Terada H, Barkovich AJ. Encephalopathy with a reversible splenial lesion is associated with hyponatremia. Brain Dev. 2009;31:217–20
Bulakbasi N, Kocaoglu M, Tayfun C, Ucoz T. Transient splenial lesion of the corpus callosum in clinically mild influenza-associated encephalitis/encephalopathy. AJNR Am J Neuroradiol. 2006;27:1983–6
Matas SL, Von Glehn F, Fernandes GB, Soares CA. Cerebrospinal fluid analysis in the context of CNS demyelinating diseases. Arq Neuropsiquiatr. 2013;71:685–8
Fukuda S, Kishi K, Yasuda K, Sejima H, Yamaguchi S. Rotavirus-associated encephalopathy with a reversible splenial lesion. Pediatr Neurol. 2009;40:131–3