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Clinically mild encephalitis/encephalopathy with a reversible splenial lesion

From the Department of Pediatrics (Drs. Tada, Takanashi, and Kohno), Chiba University Graduate School of Medicine, Chiba, Department of Radiology (Dr. Oba), Teikyo University School of Medicine, Tokyo, Department of Radiology (Dr. Maeda), Mie University School of Medicine, Mie, Department of Pediatrics (Dr. Tsukahara), Faculty of Medical Sciences, University of Fukui, Fukui, Department of Pediatrics (Dr. Suzuki), Okazaki City Hospital, Okazaki, Division of Medical Genetics (Dr. Yamamoto), Kanagawa Children’s Medical Center, Yokohama, Department of Radiology (Dr. Shimono), Kinki University School of Medicine, Osaka, Department of Pediatrics (Dr. Ichiyama), Yamaguchi University School of Medicine, Yamaguchi, Department of Radiology (Dr. Taoka), Nara Medical University, Kashihara, Division of Neurology (Dr. Sohma), Hyogo Children’s Hospital, Kobe, and Division of Neurology (Dr. Yoshikawa), Miyagi Children’s Hospital, Sendai, Japan; and Neuroradiology Section (Dr. Barkovich), Department of Radiology, University of California San Francisco.

Address correspondence and reprint requests to Dr. J.-I. Takanashi, Department of Pediatrics, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8677, Japan; e-mail: jtaka{at}faculty.chiba-u.jp

Objective: To clarify whether patients with clinical diagnoses of encephalitis/encephalopathy with a reversible lesion in the splenium of the corpus callosum (SCC) share common clinical features.

Methods: Possible encephalitis/encephalopathy patients with a reversible isolated SCC lesion on MRI were collected retrospectively. Their clinical, laboratory, and radiologic data were reviewed.

Results: Fifteen encephalitis/encephalopathy patients with a reversible isolated SCC lesion were identified among 22 patients referred for this study. All 15 patients had relatively mild clinical courses. Twelve of the 15 patients had disorders of consciousness. Eight patients had seizures, and three of them received antiepileptic drugs. All 15 patients clinically recovered completely within 1 month (8 patients within a week) after the onset of neurologic symptoms. The SCC lesion was ovoid in six patients; it extended irregularly from the center to the lateral portion of SCC in the other eight patients. Homogeneously reduced diffusion was seen in all seven patients who underwent diffusion-weighted imaging. There was no enhancement in the five patients so examined. The SCC lesion had completely disappeared in all patients at follow-up MRI exams between 3 days and 2 months after the initial MRI (within 1 week in eight patients).

Conclusion: The clinical features among the affected patients were nearly identical, consisting of relatively mild CNS manifestations and complete recovery within 1 month.

Received February 19, 2004. Accepted in final form July 21, 2004.

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