Reversible splenial lesion syndrome: two cases report and review of literature

Abstract

Objective To report 2 cases of reversible splenial lesion syndrome (RESLES) and to summarize some key points in diagnosis and treatment of this disease.  Methods The pathogenesis, clinical presentations, neuroimaging features and outcomes of 2 cases with RESLES were retrospectively analyzed and related literature was reviewed.  Results Two patients, including a 24-year-old female and an 18-year-old male, presented with sudden-onset neurologic symptoms, which became prominent after the initiation of an upper respiratory infection. Both patients were previously healthy and had no history of seizure, usage of antiepileptic drugs, or any type of vaccination during the last 2 years. Case 1 just presented with non-vertiginous dizziness. However, Case 2 presented symptoms such as dysphrenia, fever, rigidity, tremor, leukocytosis and creatine kinase (CK) elevation. Their clinical presentations were nonspecific, without evidence of callosal disconnection syndrome. They were treated with corticosteroids. Clinically, both patients were greatly improved after 14 and 21 days. Cranial MRI showed an isolated lesion centered in the splenium of the corpus callosum. The lesions were round-shaped without contrast enhancement, and disappeared after complete remission of the underlying disease.  Conclusions To our knowledge and according to previous reports, RESLES is a distinct clinicoradiological syndrome of varied etiology. In addition to sudden withdrawal of antiepileptic drugs and infection, RESLES can be caused by neuroleptic malignant syndrome (NMS). The outcome of the above mentioned cases supports the opinion that prognosis depends on the underlying disorder, but not on the presence or absence of the splenial lesion.

doi: 10.3969/j.issn.1672-6731.2014.07.007