title: Reversible splenial lesion syndrome associated with encephalitis/encephalopathy presenting with great clinical heterogeneity.
abstract: BACKGROUND
  Reversible splenial lesion syndrome (RESLES) is a disorder radiologically characterized by reversible lesion in the splenium of the corpus callosum (SCC). Most of patients with RESLES associated with encephalitis/encephalopathy were identified in Japanese population, but almost no Chinese patients were diagnosed as RESLES associated with encephalitis/encephalopathy.
  
  
  METHODS
  Possible patients with reversible isolated SCC lesions were retrieved from January 2012 to July 2015 using keyword "restricted diffusion and isolated SCC lesion" in MRI report system from a large academic center. The clinical, laboratory and radiological data were summarized.
  
  
  RESULTS
  A total of 15 encephalitis/encephalopathy patients (9 males and 6 females) were identified with a reversible isolated SCC lesion. Except for 13 patients with fever symptom, 8 patients also had cold symptoms before the onset of neurological symptoms. The neurological symptoms included headache, vertigo, seizure, disturbance of consciousness, and delirious behavior. Thirteen patients completely recovered within 1 month, but 2 patients who were subjected to mechanical ventilation had persistent neurological deficits. The initial MRI features showed isolated ovoid or extending SCC lesions with homogeneous hyperintense on diffusion weighted imaging (DWI) and decreased apparent diffusion coefficient (ADC) values. The follow-up MRI revealed that isolated SCC lesions with diffuse restriction disappeared at 10 to 32 days after the initial MRI study. Fractional anisotropy map revealed the decreased value of SCC lesion in a severe case with poor prognosis.
  
  
  CONCLUSIONS
  RESLES associated with encephalitis/encephalopathy is a reversible syndrome with an excellent prognosis in most patients, while a few patients required ventilator supporting at the early stage might have severe neurological sequelae. Reversible signal changes on DWI and ADC are identified in all patients, but fractional anisotropy values can be decreased in severe patient with neurological sequelae.
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, P. R. China.
authors.forename: Yuanzhao
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, P. R. China.
authors.forename: Junjun
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, P. R. China.
authors.forename: Ling
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Critical Care Medicine, the First Affiliated Hospital of Nanchang University, Nanchang, China.
authors.forename: Zhenguo
authors.initials: Z
authors.lastname: Zeng
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, P. R. China.
authors.forename: Min
authors.initials: M
authors.lastname: Zhu
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, P. R. China.
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Neurology, the Fourth Affiliated Hospital of Nanchang University, Nanchang, China.
authors.forename: Xiaoliang
authors.initials: X
authors.lastname: Lou
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, P. R. China.
authors.forename: Hui
authors.initials: H
authors.lastname: Wan
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, P. R. China. hongdaojun@hotmail.com.
authors.forename: Daojun
authors.initials: D
authors.lastname: Hong
mesh_terms: D000293:Adolescent; D000328:Adult; D016880:Anisotropy; D001927:Brain Diseases / Q000150:complications*; D003337:Corpus Callosum / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D004660:Encephalitis / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D013577:Syndrome; D055815:Young Adult
keywords: Corpus callosum; Encephalitis; Encephalopathy; Poor outcome; Reversible splenial lesion syndrome