Mild Encephalopathy with Reversible Lesion in the Splenium

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Magnetic resonance imaging with the typical changes in the splenium: T2-weighted hyperintense, no contrast medium absorption. Diffusion disorder was also seen.

Mild Encephalopathy with Reversible Lesion in the Splenium (MERS) describes an encephalopathy in the English specialist literature , which usually occurs in connection with infections , causes temporary neurological symptoms and usually spontaneously, i.e. without special therapy, completely regresses over the course of days to weeks .

Typical neurological complaints are headache, dizziness, delirium, speech disorders, ataxia and seizures. However, it is unclear whether these symptoms are directly related to the characteristic changes in the MRI image. Occasionally, coma and severe brain damage have been described in connection with MERS, although the simultaneous presence of other brain diseases cannot be completely ruled out. Therefore, the syndrome is alternatively referred to as "Reversible Splenial Lesion Syndrome" (RESLES for short) in order not to assume a generalized "mild" symptomatology.

The clinical picture is considered rare and so far has only been briefly mentioned in a few special textbooks. It occurs mainly in the East Asian region.

Imaging

Characteristic and thus determining the prognosis are changes in magnetic resonance tomography that are locally limited to the splenium . Changes in the signal intensity are mainly found in diffusion-weighted and T2 -weighted images in the splenium, which do not absorb any contrast agent and which, like the clinical symptoms, spontaneously decrease over time.

Most of the said lesions are limited to the splenium (type 1). Simultaneously, analogous changes in other brain regions rarely occur, which also regress after a short time (type 2).

literature

  • J. Takanashi: Two newly proposed infectious encephalitis / encephalopathy syndromes. In: Brain & development. Volume 31, Number 7, August 2009, pp. 521-528. doi: 10.1016 / j.braindev.2009.02.012 . PMID 19339128 . (Review).
  • K. Matsubara, M. Kodera, H. Nigami, K. Yura, T. Fukaya: Reversible splenial lesion in influenza virus encephalopathy. In: Pediatric neurology. Volume 37, Number 6, December 2007, pp. 431-434. doi: 10.1016 / j.pediatrneurol.2007.08.008 . PMID 18021926 . (Review).
  • J. Takanashi, AJ Barkovich, K. Yamaguchi, Y. Kohno: Influenza-associated encephalitis / encephalopathy with a reversible lesion in the splenium of the corpus callosum: a case report and literature review. In: AJNR. American journal of neuroradiology. Volume 25, Number 5, May 2004, pp. 798-802. PMID 15140723 . (Review).
  • JS Cho, SW Ha, YS Han, SE Park, KM Hong, JH Han, EK Cho, DE Kim, JG Kim: Mild encephalopathy with reversible lesion in the splenium of the corpus callosum and bilateral frontal white matter. In: Journal of clinical neurology (Seoul, Korea). Volume 3, Number 1, March 2007, pp. 53-56. doi: 10.3988 / jcn.2007.3.1.53 . PMID 19513344 . PMC 2686937 (free full text).
  • K. Linden, O. Moser, A. Simon, AM Eis-Huebinger, G. Fleischhack, M. Born, H. Tschampa, T. Rosenbaum, B. Köster, M. Lentze: [Transient splenial lesion in influenza A H1N1 2009 infection]. In: The Radiologist. Volume 51, Number 3, March 2011, pp. 220-222. doi: 10.1007 / s00117-011-2131-0 . PMID 21328046 .

Individual evidence

  1. ↑ a b Amy Ka, Philip Britton u. a .: Mild encephalopathy with reversible splenial lesion: An important differential of encephalitis. In: European Journal of Pediatric Neurology. 19, 2015, p. 377, doi: 10.1016 / j.ejpn.2015.01.011 .
  2. ↑ a b Y. Zhu, J. Zheng, L. Zhang, Z. Zeng, M. Zhu, X. Li, X. Lou, H. Wan, D. Hong: Reversible splenial lesion syndrome associated with encephalitis / encephalopathy presenting with great clinical heterogeneity. In: BMC neurology. Volume 16, April 2016, p. 49, doi: 10.1186 / s12883-016-0572-9 , PMID 27089920 , PMC 4835842 (free full text).
  3. ↑ A. James Barkovich, Charles Raybaud: Pediatric Neuroimaging 5th edition; Edited by A. James Barkovich Philadelphia, Lippincott Williams & Wilkins, 2012. ISBN 978-1-60547-714-5 . Page 1019
  4. ↑ PMID 20236662