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Reversible splenial lesion syndrome in children: a retrospective study of 130 cases
Hui Chen1,2, Xiongying Yu2, Yong Chen2
1Nanchang University, Nanchang, China.
Insights
This study analyzed 130 children with Reversible Splenial Lesion Syndrome (RESLES), finding infection as the primary cause. Age influences symptoms, with younger children experiencing more seizures and older children showing more consciousness disturbances, but all cases had a good prognosis.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Reversible Splenial Lesion Syndrome (RESLES) is a newly identified clinico-radiological syndrome.
- This study presents the largest case series of pediatric RESLES to date, analyzing 130 children in China.
Purpose of the Study:
- To retrospectively analyze the clinical features of pediatric RESLES.
- To identify age-related differences in clinical presentation and outcomes.
- To characterize the radiological findings and prognosis of RESLES in children.
Main Methods:
- Retrospective analysis of clinical data from 130 children diagnosed with RESLES between 2017 and 2023.
- Cases were divided into two age groups: ≤ 3 years (Group A) and > 3 years (Group B).
- Statistical analysis (chi-squared or Fisher's test) was used to compare clinical features between groups.
Main Results:
- Infection was the most common prodromal symptom (97.7%).
- Gastrointestinal infections were more prevalent in younger children (Group A), while respiratory infections were more common in older children (Group B).
- Younger children predominantly presented with seizures (98.8%), whereas older children exhibited more disturbance of consciousness (57.4%) and headache/dizziness (78.7%). Characteristic MRI findings of cytotoxic edema were observed, with complete lesion resolution and normal neurodevelopment in all cases.
Conclusions:
- Infection is the leading cause of RESLES in children, with specific infection types varying by age.
- Clinical manifestations of RESLES differ significantly between younger and older children.
- RESLES demonstrates characteristic MRI findings and a favorable prognosis with full recovery.
Background:
Reversible splenial lesion syndrome (RESLES) is a new clinico-radiological syndrome. We retrospectively analyzed the clinical features of 130 children with RESLES in China, which is the largest case series available in the literature.
Methods:
The clinical data of children diagnosed as RESLES in Jiangxi Provincial Children's Hospital between 2017 and 2023 were retrospectively analyzed. The 130 cases were divided into two groups: ≤ 3 years old group (group A) (n = 83) and > 3 years old group (group B) (n = 47). The chi-squared test or Fisher's test was used to evaluate the data.
Results:
The vast majority of patients (127/130 cases, 97.7%) had prodromal symptoms of infection. Preceding infections of the gastrointestinal tract were statistically more significant in group A (60/83, 72.3%) than in group B (11/47, 23.4%) (P < 0.05). Preceding infections of the respiratory tract were statistically more significant in group B (33/47, 70.2%) than in group A (17/83, 20.5%) (P < 0.05). Seizures were statistically more significant in group A (82/83, 98.8%) than in group B (24/47,51.1%) (P < 0.05). The disturbance of consciousness and headache/dizziness were statistically more significant in group B (27/47, 57.4%; 37/47, 78.7%) than in group A (3/83, 3.6%; 1/83, 1.2%), respectively (P < 0.05). Convulsions with mild gastroenteritis (CwG) were statistically more significant in group A (50/83, 60.2%) than in group B (8/47, 17.0%) (P < 0.05). However, encephalitis/encephalopathy was statistically more significant in group B (20/47, 42.6%) than in group A (10/83, 12.0%) (P < 0.05). MRI showed cytotoxic edema in typical locations (RESLES type-1 limited to the splenium of the corpus callosum and RESLES type-2 spread to the entire corpus callosum, adjacent white matter, or both). There was full recovery of the lesions of MRI in all cases from 3 days to 50 days after the initial examinations. All the children showed normal neurodevelopment.
Conclusion:
Infection was the most common cause of RESLES. Infections of the gastrointestinal tract are common in ≤ 3 years old children, while infections of the respiratory tract are common in >3 years old children. Younger patients are more likely to develop convulsions, and older children were more likely to have symptoms with disturbance of consciousness and headache/dizziness. RESLES has characteristic MRI manifestations and a good prognosis.
