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Reversible splenial lesion syndrome in children: Retrospective study and summary of case series
Wen-Xiong Chen1, Hong-Sheng Liu2, Si-Da Yang1
1Department of Neurology, Brain Center, Guangzhou Women and Children's Medical Center, Affiliated Guangzhou Medical University, Guangzhou City, Guangdong Province, China.
Insights
Reversible splenial lesion syndrome (RESLES) in children typically resolves well, but severe cases, particularly those with extra-corpus callosum lesions, may lead to lasting neurological issues like intellectual disability.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Infectious Diseases
Background:
- Reversible splenial lesion syndrome (RESLES) is a rare neurological condition.
- Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a subtype of RESLES.
Purpose of the Study:
- To detail the clinical characteristics of RESLES in pediatric patients.
- To compare severe versus non-severe RESLES cases and identify prognostic factors.
Main Methods:
- Retrospective analysis of 16 RESLES episodes in 15 children.
- Comparison of clinical and radiological features between severe and non-severe RESLES groups.
- Summary of five pediatric MERS case series.
Main Results:
- Common neurological symptoms included seizures, behavioral changes, and altered consciousness.
- Splenial lesions (SCC, extra-SCC, extra-CC) showed characteristic MRI findings.
- Most patients recovered fully, but severe cases with extra-CC lesions had a higher risk of neurological sequelae, including intellectual disability.
Conclusions:
- RESLES in children generally has a favorable prognosis.
- Severe RESLES, especially with extra-corpus callosum lesions, warrants closer monitoring due to potential for neurological sequelae.
Objective:
To describe clinical features of reversible splenial lesion syndrome (RESLES) in children.
Methods:
Retrospectively analyzed clinical features of RESLES in children and compared differences between severe and non-severe group, classified by clinical global impression-scale; summarized clinical features of children with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) from case series.
Results:
16 episodes of RESLES occurring in 15 Chinese children were analyzed, with 13 episodes having MERS and 3 episodes with epilepsy. 10 episodes were associated with various pathogens including rotavirus (n=5), adenovirus (n=1), influenza A (n=1), mycoplasma (n=2), and jejunum campylobacter (n=1). The common neurological symptoms included seizure, behavioral changes, altered consciousness and motor deterioration. The lesions of splenium of corpus callosum (SCC), extra-SCC (n=2) or extra-CC (n=1) showed T2-weight and FLAIR hyper-intensity, with the corresponding reduced diffusion. All had complete resolution of radiological changes except 1 episode with small residual. 8 episodes had EEG abnormalities, while elevated white blood count, increased hs-CRP, and hyponatremia were commonly revealed. 7 episodes were given steroid plus therapy, while 3 episodes were treated with antiepileptic drugs. Compared with non-severe group, the number of patients with altered consciousness, EEG abnormalities, motor deterioration, or extra-SCC lesions in severe group was significantly increased. The patients in severe group tended to need longer hospital stay interval. No case caused neurological sequelae, except 1 patient in severe group with recurrent episode and extra-CC lesions having intellectual disability (ID). Five pediatric MERS case series were summarized, including 67 episodes (40 male and 27 female; age ranging 10 m∼13y) from 65 patients, with 33 episodes in Japan, 27 in China, and 7 in Caucasian Australian children, and all patients have a good prognosis except 1 patient with ID (current study).
Conclusion:
Although RESLES in children tend to be a good outcome, the prognosis of patient in severe group, especially with extra-CC lesions, might have neurological sequelae.
