title: Reversible splenial lesion syndrome in children: Retrospective study and summary of case series.
abstract: OBJECTIVE
  To describe clinical features of reversible splenial lesion syndrome (RESLES) in children.
  
  
  METHODS
  Retrospectively analyzed clinical features of RESLES in children and compared differences between severe and non-severe group, classified by clinical global impression-scale; summarized clinical features of children with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) from case series.
  
  
  RESULTS
  16 episodes of RESLES occurring in 15 Chinese children were analyzed, with 13 episodes having MERS and 3 episodes with epilepsy. 10 episodes were associated with various pathogens including rotavirus (n=5), adenovirus (n=1), influenza A (n=1), mycoplasma (n=2), and jejunum campylobacter (n=1). The common neurological symptoms included seizure, behavioral changes, altered consciousness and motor deterioration. The lesions of splenium of corpus callosum (SCC), extra-SCC (n=2) or extra-CC (n=1) showed T2-weight and FLAIR hyper-intensity, with the corresponding reduced diffusion. All had complete resolution of radiological changes except 1 episode with small residual. 8 episodes had EEG abnormalities, while elevated white blood count, increased hs-CRP, and hyponatremia were commonly revealed. 7 episodes were given steroid plus therapy, while 3 episodes were treated with antiepileptic drugs. Compared with non-severe group, the number of patients with altered consciousness, EEG abnormalities, motor deterioration, or extra-SCC lesions in severe group was significantly increased. The patients in severe group tended to need longer hospital stay interval. No case caused neurological sequelae, except 1 patient in severe group with recurrent episode and extra-CC lesions having intellectual disability (ID). Five pediatric MERS case series were summarized, including 67 episodes (40 male and 27 female; age ranging 10 m∼13y) from 65 patients, with 33 episodes in Japan, 27 in China, and 7 in Caucasian Australian children, and all patients have a good prognosis except 1 patient with ID (current study).
  
  
  CONCLUSIONS
  Although RESLES in children tend to be a good outcome, the prognosis of patient in severe group, especially with extra-CC lesions, might have neurological sequelae.
authors: Department of Neurology, Brain Center, Guangzhou Women and Children's Medical Center, Affiliated Guangzhou Medical University, Guangzhou City, Guangdong Province, China. Electronic address: gzchcwx@126.com.
authors: Wen-Xiong
authors: WX
authors: Chen
authors: MRI Center, Department of Radiology, Guangzhou Women and Children's Medical Center, Affiliated Guangzhou Medical University, Guangzhou City, Guangdong Province, China.
authors: Hong-Sheng
authors: HS
authors: Liu
authors: Department of Neurology, Brain Center, Guangzhou Women and Children's Medical Center, Affiliated Guangzhou Medical University, Guangzhou City, Guangdong Province, China.
authors: Si-Da
authors: SD
authors: Yang
authors: MRI Center, Department of Radiology, Guangzhou Women and Children's Medical Center, Affiliated Guangzhou Medical University, Guangzhou City, Guangdong Province, China.
authors: Si-Hui
authors: SH
authors: Zeng
authors: Department of Neurology, Brain Center, Guangzhou Women and Children's Medical Center, Affiliated Guangzhou Medical University, Guangzhou City, Guangdong Province, China.
authors: Yuan-Yuan
authors: YY
authors: Gao
authors: Department of Neurology, Brain Center, Guangzhou Women and Children's Medical Center, Affiliated Guangzhou Medical University, Guangzhou City, Guangdong Province, China.
authors: Zhi-Hong
authors: ZH
authors: Du
authors: Department of Neurology, Brain Center, Guangzhou Women and Children's Medical Center, Affiliated Guangzhou Medical University, Guangzhou City, Guangdong Province, China.
authors: Xiao-Jing
authors: XJ
authors: Li
authors: Department of Neurology, Brain Center, Guangzhou Women and Children's Medical Center, Affiliated Guangzhou Medical University, Guangzhou City, Guangdong Province, China.
authors: Hai-Sheng
authors: HS
authors: Lin
authors: Department of Neurology, Brain Center, Guangzhou Women and Children's Medical Center, Affiliated Guangzhou Medical University, Guangzhou City, Guangdong Province, China.
authors: Hui-Ci
authors: HC
authors: Liang
authors: Department of Neurology, Brain Center, Guangzhou Women and Children's Medical Center, Affiliated Guangzhou Medical University, Guangzhou City, Guangdong Province, China.
authors: Jian-Ning
authors: JN
authors: Mai
mesh_terms: D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology; D001927:Brain Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013577:Syndrome
keywords: Case series; Children; Clinical feature; Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS); Epilepsy; Magnetic resonance image (MRI); Reversible splenial lesion syndrome (RESLES)