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Clinical Medical
Image Library
ISSN: 2474-3682
IMAGE ARTICLE | VOLUME 4, ISSUE 4 | OPEN ACCESS DOI: 10.23937/2474-3682/1510096

Mild Encephalopathy with a Reversible Splenial Lesion Mimicking Transient İschemic Attack

Serdar Arslan , Hasan Erdogan, Fatma Zeynep Arslan, Mehmet Sedat Durmaz, Nahide Baran and Ismet Tolu

Department of Radiology, Konya Education and Research Hospital, University of Health Sciences, Konya, Turkey

*Corresponding author: Serdar Arslan, MD, Specialist, Department of Radiology, Konya Education and Research Hospital, University of Health Sciences, 42090, Meram, Konya, Turkey, Tel: +90-555-866-0621, E-mail: arslanserdar10@gmail.com

Accepted: July 23, 2018 | Published: July 25, 2018

Citation: Arslan S, Erdogan H, Arslan FZ, Durmaz MS, Baran N, et al. (2018) Mild Encephalopathy with a Reversible Splenial Lesion Mimicking Transient İschemic Attack. Clin Med Img Lib 4:096. doi.org/10.23937/2474-3682/1510096

Copyright: © 2018 Arslan S, et al. This is an open-access content distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Keywords


Encephalopathy, Corpus callosum, Splenium, Transient ischemic attack, Diffusion, MRI

A 21-year-old man was admitted to emergency department due to slurred speech, weakness and loss of consciousness. The previous history is unremarkable except a slight cold 2 weeks ago. The first magnetic resonance imaging (MRI) revealed a distinct lesion involving in the splenium of the corpus callosum. This lesion showed restricted diffusion with hyperintense signal on diffusion-weighted imaging (DWI) and hypointense signal on apparent diffusion coefficient (ADC) sequence (Figure 1). A follow-up brain MRI scan was performed 9 days after onset of disease. Reduced lesions with decreased signals were discovered in DWI and ADC.

Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) is a newly minted syndrome that was first described by Tada, et al. in 2004 as a rare clinico-radiological syndrome in 2004 [1]. Patients with MERS presented with mild central nervous system symptoms such as consciousness disturbance, seizures and headache and recovered completely within a month [2]. Many child-onset MERS cases have been reported in the litarature. However, adult onset MERS is rare [3]. The pathogenesis of MERS is still unknown. Several hypotheses have been proposed for pathogenesis of the specific lesion, such as intramyelinic edema, hyponatremia, axonal damage, and oxidative stress [1,3]. High signal intensity on DWI and decreased ADC values of splenium of the corpus callosum have been observed in MERS. ADC may return to normal within a week if the intramyelinic edema or inflammatory infiltrate resolves quickly [2].

Source(S) of Support


None.

Conflicting Interest


None.

Figures



Figure 1: A lesion in the splenium part of the corpus callosum shows restricted diffusion with hyperintense signal on diffusion-weighted imaging (DWI) and hypointense signal on apparent diffusion coefficient (ADC) sequence.

References


  1. K Dong, Q Zhang, J Ding, L Ren, Z Zhang, et al. (2016) Mild encephalopathy with a reversible splenial lesion mimicking transient ischemic attack: A case report. Medicine (Baltimore) 95: e5258.

  2. JJ Pan, YY Zhao, C Lu, YH Hu, Y Yang (2015) Mild encephalitis/encephalopathy with a reversible splenial lesion: Five cases and a literature review. Neurol Sci 36: 2043-2051.

  3. H Takatsu, N Ishimaru, M Ito, S Kinami (2017) Mild encephalitis/encephalopathy with a reversible splenial lesion in an adult patient with influenza. Intern Med 56: 3093-3095.