Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2017

Open Access 01-12-2017 | Case Report

Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) in adults-a case report and literature review

Authors: Junliang Yuan, Shuna Yang, Shuangkun Wang, Wei Qin, Lei Yang, Wenli Hu

Published in: BMC Neurology | Issue 1/2017

Login to get access

Abstract

Background

Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) is a rare clinico-radiological entity characterized by the magnetic resonance imaging (MRI) finding of a reversible lesion in the corpus callosum, sometimes involved the symmetrical white matters. Many cases of child-onset MERS with various causes have been reported. However, adult-onset MERS is relatively rare. The clinical characteristics and pathophysiologiccal mechanisms of adult-onset MERS are not well understood. We reviewed the literature on adult-onset MERS in order to describe the characteristics of MERS in adults and to provide experiences for clinician.

Methods

We reported a case of adult-onset MERS with acute urinary retension and performed literature search from PubMed and web of science databases to identify other adult-onset MERS reports from Januarary 2004 to March 2016. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed on selection process. And then we summarized the clinico-radiological features of adult-onset MERS.

Results

Twenty-nine adult-onset MERS cases were reviewed from available literature including the case we have. 86.2% of the cases (25/29) were reported in Asia, especially in Japan. Ages varied between 18 and 59 years old with a 12:17 female-to-male ratio. The major cause was infection by virus or bacteria. Fever and headache were the most common clinical manifestation, and acute urinary retention was observed in 6 patients. All patients recovered completely within a month.

Conclusion

Adult-onset MERS is an entity with a broad clinico-radiological spectrum because of the various diseases and conditions. There are similar characteristics between MERS in adults and children, also some differences.
Literature
1.
Tada H, Takanashi J, Barkovich A, et al. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion. Neurology. 2004;63:1854–8.CrossRefPubMed
2.
Garcia-Monco JC, Cortina IE, Ferreira E, et al. Reversible splenial lesion syndrome (RESLES): what's in a name? J Neuroimaging. 2011;21:e1–e14.CrossRefPubMed
3.
Takanashi J-i. Two newly proposed infectious encephalitis/encephalopathy syndromes. Brain Dev. 2009;31:521–8.
4.
Takanashi J, Barkovich A, Shiihara T, et al. Widening spectrum of a reversible splenial lesion with transiently reduced diffusion. Am J Neuroradiol. 2006;27:836–8.PubMed
5.
Notebaert A, Willems J, Coucke L, Van Coster R, Verhelst H. Expanding the spectrum of MERS type 2 lesions, a particular form of encephalitis. Pediatr Neurol. 2013;48:135–8.CrossRefPubMed
6.
Cho J-S, Ha S-W, Han Y-S, et al. Mild encephalopathy with reversible lesion in the splenium of the corpus callosum and bilateral frontal white matter. J Clin Neurol. 2007;3:53–6.CrossRefPubMedPubMedCentral
7.
Takanashi J-i, Barkovich AJ, Yamaguchi K-i, Kohno Y. Influenza-associated encephalitis/encephalopathy with a reversible lesion in the splenium of the corpus callosum: a case report and literature review. Am J Neuroradiol. 2004;25:798–802.
8.
Fuchigami T, Goto K, Hasegawa M, et al. A 4-year-old girl with clinically mild encephalopathy with a reversible splenial lesion associated with rotavirus infection. J Infect Chemother. 2013;19:149–53.CrossRefPubMed
9.
Takanashi J-i, Shiihara T, Hasegawa T, et al. Clinically mild encephalitis with a reversible splenial lesion (MERS) after mumps vaccination. J Neurol Sci. 2015;349:226–8.CrossRef
10.
Shibuya H, Osamura K, Hara K, Hisada T. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion due to Mycoplasma pneumoniae infection. Intern Med. 2012;51:1647–8.CrossRefPubMed
11.
Tomizawa Y, Hoshino Y, Sasaki F, et al. Diagnostic utility of Splenial lesions in a case of Legionnaires’ disease due to Legionella pneumophila Serogroup 2. Intern Med. 2015;54:3079–82.CrossRefPubMed
12.
Kim SS, Chang K-H, Kim ST, et al. Focal lesion in the splenium of the corpus callosum in epileptic patients: antiepileptic drug toxicity? Am J Neuroradiol. 1999;20:125–9.PubMed
13.
Polster T, Hoppe M, Ebner A. Transient lesion in the splenium of the corpus callosum: three further cases in epileptic patients and a pathophysiological hypothesis. J Neurol Neurosurg Psychiatry. 2001;70:459–63.CrossRefPubMedPubMedCentral
14.
Maeda M, Shiroyama T, Tsukahara H, Shimono T, Aoki S, Takeda K. Transient splenial lesion of the corpus callosum associated with antiepileptic drugs: evaluation by diffusion-weighted MR imaging. Eur Radiol. 2003;13:1902–6.CrossRefPubMed
15.
Karampatsas K, Spyridou C, Morrison IR, Tong CY, Prendergast AJ. Rotavirus-associated mild encephalopathy with a reversible splenial lesion (MERS)—case report and review of the literature. BMC Infect Dis. 2015;15:1.CrossRef
16.
Barkovich AJ. Pediatric neuroimaging: Lippincott Williams & Wilkins, 2005.
17.
Miyata R, Tanuma N, Hayashi M, et al. Oxidative stress in patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). Brain Dev. 2012;34:124–7.CrossRefPubMed
18.
Takanashi J-i, Maeda M, Hayashi M. Neonate showing reversible splenial lesion. Arch Neurol. 2005;62:1481–2.CrossRef
19.
Engelbrecht V, Scherer A, Rassek M, Witsack HJ, Mödder U. Diffusion-weighted MR imaging in the brain in children: findings in the normal brain and in the brain with white matter diseases 1. Radiology. 2002;222:410–8.CrossRefPubMed
20.
Phillips MD, McGraw P, Lowe MJ, Mathews VP, Hainline BE. Diffusion-weighted imaging of white matter abnormalities in patients with phenylketonuria. Am J Neuroradiol. 2001;22:1583–6.PubMed
21.
Takanashi J-i, Tada H, Maeda M, Suzuki M, Terada H, Barkovich AJ. Encephalopathy with a reversible splenial lesion is associated with hyponatremia. Brain Dev. 2009;31:217–20.
22.
Takanashi J-i, Hirasawa K-i, Tada H. Reversible restricted diffusion of entire corpus callosum. J Neurol Sci. 2006;247:101–4.
23.
Hong JM, Park MS, Jun D. Transient splenial lesion of the corpus callosum in patients with infectious disease. J Korean Neurol Assoc. 2005;23:667–70.
24.
Dyken PR. Viral diseases of the nervous system. Pediatr Neurol. 1994;1:499–501.
25.
Friese S, Bitzer M, Freudenstein D, Voigt K, Küker W. Classification of acquired lesions of the corpus callosum with MRI. Neuroradiology. 2000;42:795–802.CrossRefPubMed
26.
Mizuguchi M, Yamanouchi H, Ichiyama T, Shiomi M. Acute encephalopathy associated with influenza and other viral infections. Acta Neurol Scand. 2007;115:45–56.CrossRefPubMed
27.
Tascilar N, Aydemir H, Emre U, Unal A, Atasoy HT, Ekem S. Unusual combination of reversible splenial lesion and meningitis-retention syndrome in aseptic meningomyelitis. Clinics. 2009;64:932–7.CrossRefPubMedPubMedCentral
28.
Kitami M, Kubo S-i, Nakamura S, Shiozawa S, Isobe H, Furukawa Y. Acute urinary retention in a 23-year-old woman with mild encephalopathy with a reversible splenial lesion: a case report. J Med Case Rep. 2011;5:159.CrossRefPubMedPubMedCentral
29.
Vollmann H, Hagemann G, Mentzel H-J, Witte OW, Redecker C. Isolated reversible splenial lesion in tick-borne encephalitis: a case report and literature review. Clin Neurol Neurosurg. 2011;113:430–3.CrossRefPubMed
30.
Renard D, Taieb G, Briere C, Bengler C, Castelnovo G. Mild encephalitis/encephalopathy with a reversible splenial, white matter, putaminal, and thalamic lesions following anti-Yo rhombencephalitis. Acta Neurol Belg. 2012;112:405-7.
31.
Mitaki S, Onoda K, Ishihara M, Nabika Y, Yamaguchi S. Dysfunction of default-mode network in encephalopathy with a reversible corpus callosum lesion. J Neurol Sci. 2012;317:154–6.CrossRefPubMed
32.
Shankar B, Narayanan R, Muralitharan P, Ulaganathan B. Evaluation of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) by diffusion-weighted and diffusion tensor imaging. BMJ case reports. 2014;2014:bcr2014204078.CrossRefPubMedPubMedCentral
33.
Ko SY, Kim BK, Kim DW, et al. Reversible splenial lesion on the corpus callosum in nonfulminant hepatitis a presenting as encephalopathy. Clin Mol Hepatol. 2014;20:398–401.CrossRefPubMedPubMedCentral
34.
Hibino M, Horiuchi S, Okubo Y, Kakutani T, Ohe M, Kondo T. Transient Hemiparesis and Hemianesthesia in an atypical case of adult-onset clinically mild encephalitis/encephalopathy with a reversible Splenial lesion associated with adenovirus infection. Intern Med. 2014;53:1183–5.CrossRefPubMed
35.
Conry RM, Sullivan JC, Nabors LB. Ipilimumab-induced encephalopathy with a reversible splenial lesion. Cancer Immunol Res. 2015;3:598–601.CrossRefPubMed
36.
Pan JJ, Zhao Y-y, Lu C, Hu YH, Yang Y. Mild encephalitis/encephalopathy with a reversible splenial lesion: five cases and a literature review. Neurol Sci. 2015;36:2043–51.
37.
Zhang S, Ma Y, Feng J. Clinicoradiological spectrum of reversible splenial lesion syndrome (RESLES) in adults: a retrospective study of a rare entity. Med. 2015;94(6):e512.
38.
Degirmenci E, Degirmenci T, Cetin EN, Kıroğlu Y. Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in a patient presenting with papilledema. Acta Neurol Belg. 2015;115:153–5.CrossRefPubMed
39.
Alakbarova N, Eraslan C, Celebisoy N, Karasoy H, Gonul AS. Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) development after Amanita phalloides intoxication. Acta Neurol Belg. 2015:1–3.
40.
Gawlitza M, Hoffmann KT, Lobsien D. Mild encephalitis/encephalopathy with reversible Splenial and Cerebellar lesions (MERS type II) in a patient with hemolytic uremic syndrome (HUS). J Neuroimaging. 2015;25:145–6.CrossRefPubMed
Metadata
Title
Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) in adults-a case report and literature review
Authors
Junliang Yuan
Shuna Yang
Shuangkun Wang
Wei Qin
Lei Yang
Wenli Hu
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2017
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-017-0875-5

Other articles of this Issue 1/2017

BMC Neurology 1/2017 Go to the issue

Research article

Single-fiber electromyography in the orbicularis oculi muscle in patients with ocular myasthenia gravis symptoms: does abnormal jitter predict response to treatment?

Research article

Monitoring training activity during gait-related balance exercise in individuals with Parkinson’s disease: a proof-of-concept-study

Case report

A possible role of low regulatory T cells in anti-acetylcholine receptor antibody positive myasthenia gravis after bone marrow transplantation

Case report

Supernumerary phantom limb in a patient with basal ganglia hemorrhage - a case report and review of the literature

Research article

Low threshold unmyelinated mechanoafferents can modulate pain

Case report

A case report of thoracolumbar paraspinal myopathy as the cause of camptocormia in a patient with atypical parkinsonism