title: Mild encephalitis/encephalopathy with a reversible splenial lesion in children.
abstract: Authors, most of them Japanese, have recently published an increasing number of articles on mild encephalitis/encephalopathy with a reversible splenial lesion. We report on two new white European patients and compare published data with our own observations. A 15-year-old girl developed headache, fever, dizziness, vomiting and nuchal rigidity over four days. CSF showed elevated protein and cell count, with the lowest serum Na being 131 mmol/L. MRI on day seven was normal, but she remained febrile, had cerebral edema and episodes of confusion. MRI on day 11 showed a small T2-hyperintense lesion with restricted diffusion in the callosal splenium. Adenoviral infection was proved, and the girl underwent a protracted course of recovery. MRI signal changes improved in six days and disappeared after four months. A 12.5-year-old girl developed headache, lethargy, drowsiness and vomiting. On day five she experienced right-sided numbness, weakness and inability to speak which lasted 12 hours. She was confused and disoriented. MRI disclosed a tiny area of increased T2-signal and restricted diffusion in the splenium. Serum Na was 133 mmol/L, CSF cell count and protein was markedly elevated, and enteroviral infection was detected. Echocardiography showed no changes predisposing to clot formation and no thrombophilia was found. Her symptoms resolved in a week and MRI was normal two months later. These two non-epileptic children increase the small number of white European patients with MERS reported so far. Both had hyponatremia and encephalitis and patient 2 had transient ischemic attack, possibly due to the cerebral edema also resulting in the splenial lesion.
authors.affiliation: Department of Paediatrics, Szent László Hospital, Budapest. zliptai@laszlokorhaz.hu
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Liptai
authors.forename: Balázs
authors.initials: B
authors.lastname: Ivády
authors.forename: Péter
authors.initials: P
authors.lastname: Barsi
authors.forename: György
authors.initials: G
authors.lastname: Várallyay
authors.forename: Gábor
authors.initials: G
authors.lastname: Rudas
authors.forename: András
authors.initials: A
authors.lastname: Fogarasi
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D058633:Antipyretics / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D001921:Brain / Q000473:pathology*; D001929:Brain Edema / Q000209:etiology / Q000473:pathology; D002648:Child; D003337:Corpus Callosum / Q000473:pathology; D004234:Diuretics, Osmotic / Q000008:administration & dosage; D004660:Encephalitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D018792:Encephalitis, Viral / Q000175:diagnosis; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000473:pathology; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008353:Mannitol / Q000008:administration & dosage; D008775:Methylprednisolone / Q000008:administration & dosage; D018696:Neuroprotective Agents / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D058633:Antipyretics; D004234:Diuretics, Osmotic; D018696:Neuroprotective Agents; D008353:Mannitol; D001241:Aspirin; D008775:Methylprednisolone