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Mild encephalopathy/encephalitis with a reversible splenial lesion (MERS): A report of five neonatal cases
Dan Sun1, Wen-Hong Chen2, Suraj Baralc3
1Department of Pediatric Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China.
Abstract:
Mild encephalopathy/encephalitis with a reversible splenial (MERS) lesion is a clinic-radiological entity. The clinical features of MERS in neonates are still not systemically reported. This paper presents five cases of MERS, and the up-to-date reviews of previously reported cases were collected and analyzed in the literature. Here we describe five cases clinically diagnosed with MERS. All of them were neonates and the average age was about 4 days. They were admitted for the common neurological symptoms such as hyperspasmia, poor reactivity and delirium. Auxiliary examinations during hospitalization also exhibited features in common. In this report, we reached following conclusions. Firstly, magnetic resonance imaging revealed solitary or comprehensive lesions in the splenium of corpus callosum, some of them extending to almost the whole corpus callosum. The lesions showed low intensity signal on T1-weighted images, homogeneously hyperintense signal on T2-weighted images, fluid-attenuated inversion recovery and diffusion-weighted images, and exhibited an obvious reduced diffusion on apparent diffusion coefficient map. Moreover, the lesions in the magnetic resonance imaging disappeared very quickly even prior to the clinical recovery. Secondly, all the cases depicted here suffered electrolyte disturbances especially hyponatremia which could be easily corrected. Lastly, all of the cases recovered quickly over one week to one month and majority of them exhibited signs of infections and normal electroencephalography.
Insights
Mild encephalopathy/encephalitis with a reversible splenial (MERS) lesion is a rare condition in newborns. This study details five cases, highlighting rapid MRI lesion resolution and electrolyte imbalances, primarily hyponatremia, in affected neonates.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Mild encephalopathy/encephalitis with a reversible splenial (MERS) lesion is a clinic-radiological entity.
- Clinical features of MERS in neonates are not well-documented.
- This study presents five neonatal MERS cases and reviews existing literature.
Observation:
- Five neonates (average age 4 days) presented with neurological symptoms like hyperspasmia, poor reactivity, and delirium.
- Magnetic resonance imaging (MRI) revealed characteristic splenial lesions in the corpus callosum.
- Lesions showed specific signal intensities on T1, T2, FLAIR, and DWI sequences with restricted diffusion.
Findings:
- Splenial lesions on MRI resolved rapidly, often preceding clinical recovery.
- All cases experienced electrolyte disturbances, notably hyponatremia, which was correctable.
- Most neonates had signs of infection, normal electroencephalography (EEG), and recovered within 1-4 weeks.
Implications:
- This study expands the understanding of MERS in neonates, a population with limited reported data.
- The rapid MRI resolution and association with electrolyte imbalances, particularly hyponatremia, are key diagnostic features.
- Findings suggest MERS is a distinct entity with a generally favorable prognosis in neonates, often linked to infection.
