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Neuropediatrics 2018; 49(01): 068-071
DOI: 10.1055/s-0037-1608779
Short Communication
Georg Thieme Verlag KG Stuttgart · New York

Mild Encephalitis/Encephalopathy with Reversible Splenial Lesion (MERS) due to Cytomegalovirus: Case Report and Review of the Literature

Paola Feraco
1   Department of Radiology, Ospedale S. Chiara, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
,
Giulia Porretti
2   Department of Radiology, Borgo Roma Hospital, Verona, Italy
,
Giuliana Marchiò
3   Department of Pediatric Neuropsychiatry, Ospedale S. Chiara, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
,
Maria Bellizzi
4   Department of Pediatrics, Ospedale S. Chiara, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
,
Mauro Recla
1   Department of Radiology, Ospedale S. Chiara, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
› Author Affiliations
Further Information

Publication History

25 June 2017

03 October 2017

Publication Date:
27 November 2017 (online)

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Abstract

Mild encephalopathy with a reversible splenial lesion (MERS) is a clinico-radiological syndrome characterized by a transient mild encephalopathy and MRI findings of a reversible lesion in the splenium of corpus callosum (SCC). It is classified in MERS type I and MERS type II, depending on the involvement of SCC alone or also other white matter areas. The syndrome mainly affects children and young adults; the prognosis is favorable with complete or nearly complete neurological and radiological resolution within days or weeks. The vast majority of the cases described in the literature involve Asian and Australian children. The exact pathophysiology is unknown; however, infectious-related MERS (in particular virus associated MERS) remains the most common cause of reversible splenial lesions in childhood. To the best of our knowledge, there is only one published case of MERS associated with cytomegalovirus (CMV) infection involving an Australian child. We present here the first case of a CMV-related MERS in a European Caucasian child.

Keywords

MERS - CMV - splenial reversible lesion
 

  • References

  • 1 Chaudhuri A, Kennedy PG. Diagnosis and treatment of viral encephalitis. Postgrad Med J 2002; 78 (924) 575-583
    CrossrefPubMedGoogle Scholar
  • 2 Chen WX, Liu HS, Yang SD. , et al. Reversible splenial lesion syndrome in children: Retrospective study and summary of case series. Brain Dev 2016; 38 (10) 915-927
    CrossrefPubMedGoogle Scholar
  • 3 Fong CY, Khine MM, Peter AB, Lim WK, Rozalli FI, Rahmat K. Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) due to dengue virus. J Clin Neurosci 2017; 36: 73-75
    CrossrefPubMedGoogle Scholar
  • 4 Fang Q, Chen L, Chen Q, Lin Z, Yang F. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion of corpus callosum in Chinese children. Brain Dev 2017; 39 (04) 321-326
    CrossrefPubMedGoogle Scholar
  • 5 Kosami K, Kenzaka T, Sagara Y, Minami K, Matsumura M. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion caused by methicillin-sensitive Staphylococcus aureus bacteremia with toxic shock syndrome: a case report. BMC Infect Dis 2016; 16: 160
    CrossrefPubMedGoogle Scholar
  • 6 Jinnai A, Kikuchi T, Ishikawa M, Nishimura Y, Shibata K, Sakura H. [A case of rubella encephalitis presenting as clinically mild encephalitis/encephalopathy with a reversible splenial lesion] [Article in Japanese]. Rinsho Shinkeigaku 2014; 54 (08) 668-670
    CrossrefPubMedGoogle Scholar
  • 7 Man BL, Fu YP. The first case of mild encephalopathy with a reversible splenial lesion due to Japanese encephalitis virus infection. BMJ Case Rep 2013; 2013: bcr2013200988
    CrossrefPubMedGoogle Scholar
  • 8 Hoshino A, Saitoh M, Oka A. , et al. Epidemiology of acute encephalopathy in Japan, with emphasis on the association of viruses and syndromes. Brain Dev 2012; 34 (05) 337-343
    CrossrefPubMedGoogle Scholar
  • 9 Ka A, Britton P, Troedson C. , et al. Mild encephalopathy with reversible splenial lesion: an important differential of encephalitis. Eur J Paediatr Neurol 2015; 19 (03) 377-382
    CrossrefPubMedGoogle Scholar
  • 10 Liptai Z, Ivády B, Barsi P, Várallyay G, Rudas G, Fogarasi A. Mild encephalitis/encephalopathy with a reversible splenial lesion in children. Ideggyogy Sz 2013; 66 (1-2): 67-71
    PubMedGoogle Scholar
  • 11 Wang J, Stewart E, Dapaah-Afriyie K, Finn A. Mild encephalopathy with reversible splenial lesion in a patient with influenza A infection--first report in an adult patient in the USA. BMJ Case Rep 2015; 2015 DOI: 10.1136/bcr-2015-210197.
    CrossrefPubMedGoogle Scholar
  • 12 Nagpal K, Agarwal P, Kumar A, Reddi R. Chikungunya infection presenting as mild encephalitis with a reversible lesion in the splenium: a case report. J Neurovirol 2017; 23 (03) 501-503
    CrossrefPubMedGoogle Scholar
  • 13 Takanashi J. Two newly proposed infectious encephalitis/encephalopathy syndromes. Brain Dev 2009; 31 (07) 521-528
    CrossrefPubMedGoogle Scholar
  • 14 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 Rep 2014; 2014: bcr2014204078
    CrossrefPubMedGoogle Scholar
  • 15 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 (02) 124-127
    CrossrefPubMedGoogle Scholar