title: Clinico-radiological spectrum of reversible splenial lesions in children.
abstract: Recently, many cases of children presenting reversible splenial lesions during febrile illness (RESLEF) have been reported; however, their overall clinico-radiological features are unclear. To describe the clinico-radiological features, we retrospectively reviewed the etiology (pathogen), clinical course, laboratory data, magnetic resonance imaging and electroencephalography (EEG) findings, therapy, and prognosis of 23 episodes in 22 children (1 child recurred) who presented neurological symptoms, with RESLEF. The etiologies (pathogens) varied. Seizure occurred in 7 episodes, disturbance of consciousness (DC) in 13, and delirious behavior in 18. Serum sodium levels <136 mEq/L were observed in 18 episodes. Lesions outside the splenium were found in 4 cases. Slow waves were observed on EEG in 10 episodes. Methylprednisolone pulse therapy was given in 7 cases. No case resulted in neurological sequelae. Among 23 episodes, clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) was diagnosed in 6 episodes, whereas non-MERS was observed in 17 episodes. No difference was observed in almost all the clinico-radiological features' data between the 2 groups. The largest differences were observed in the rate of purposeless movement, DC, extension of the abnormal lesions outside the splenium, and marked slowing of background activity on EEG. RESLEF exhibit a spectrum of clinico-radiological features. These results suggest that non-MERS and MERS both are a part of a larger pathological condition, which we have termed as RESLEF spectrum syndrome. Given the view that such a syndrome exists, the clinical characteristics and position of non-MERS and MERS become clear.
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan. Electronic address: dbs003@art.osaka-med.ac.jp.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kashiwagi
authors.affiliation: Department of Child Neurology, Tanabe Kadobayashi Children's Clinic, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Tanabe
authors.affiliation: Department of Pediatrics, Osaka Medical College, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Shimakawa
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan; Department of Pediatrics, Osaka Medical College, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Murata
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan; Department of Pediatrics, Osaka Medical College, Japan.
authors.forename: Kousuke
authors.initials: K
authors.lastname: Shabana
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan; Department of Pediatrics, Osaka Medical College, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Shinohara
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan; Department of Pediatrics, Nagano Children's Hospital, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Odanaka
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Matsumura
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Koh
authors.initials: K
authors.lastname: Maki
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Okumura
authors.affiliation: Department of Pediatrics, Hirakata City Hospital, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Okasora
authors.affiliation: Department of Pediatrics, Osaka Medical College, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tamai
mesh_terms: D001774:Blood Chemical Analysis; D001927:Brain Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003337:Corpus Callosum / Q000473:pathology*; D018450:Disease Progression; D004569:Electroencephalography; D005260:Female; D005334:Fever / Q000150:complications; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D003294:Seizures, Febrile / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D013577:Syndrome
keywords: Clinically mild encephalitis/encephalopathy; Delirious behavior; Disturbance of consciousness; RESLEF spectrum syndrome; Reversible splenial lesions during febrile illness; Spectrum of clinico-radiological features