Reversible splenial lesion syndrome in children: a retrospective study of 130 cases

Hui Chen; Xiongying Yu; Yong Chen; Huaping Wu; Zhuqiang Wu; Jianmin Zhong; Zhenyu Tang

doi:10.3389/fneur.2023.1241549

Reversible splenial lesion syndrome in children: a retrospective study of 130 cases

Front Neurol. 2023 Sep 5:14:1241549. doi: 10.3389/fneur.2023.1241549. eCollection 2023.

Authors

Hui Chen^{1

2}, Xiongying Yu², Yong Chen², Huaping Wu², Zhuqiang Wu³, Jianmin Zhong², Zhenyu Tang⁴

Affiliations

¹ Nanchang University, Nanchang, China.
² Department of Neurology, Children's Hospital of Jiangxi Province, Nanchang, China.
³ Department of Magnetic Resonance, Children's Hospital of Jiangxi Province, Nanchang, China.
⁴ Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China.

Abstract

Background: Reversible splenial lesion syndrome (RESLES) is a new clinico-radiological syndrome. We retrospectively analyzed the clinical features of 130 children with RESLES in China, which is the largest case series available in the literature.

Methods: The clinical data of children diagnosed as RESLES in Jiangxi Provincial Children's Hospital between 2017 and 2023 were retrospectively analyzed. The 130 cases were divided into two groups: ≤ 3 years old group (group A) (n = 83) and > 3 years old group (group B) (n = 47). The chi-squared test or Fisher's test was used to evaluate the data.

Results: The vast majority of patients (127/130 cases, 97.7%) had prodromal symptoms of infection. Preceding infections of the gastrointestinal tract were statistically more significant in group A (60/83, 72.3%) than in group B (11/47, 23.4%) (P < 0.05). Preceding infections of the respiratory tract were statistically more significant in group B (33/47, 70.2%) than in group A (17/83, 20.5%) (P < 0.05). Seizures were statistically more significant in group A (82/83, 98.8%) than in group B (24/47,51.1%) (P < 0.05). The disturbance of consciousness and headache/dizziness were statistically more significant in group B (27/47, 57.4%; 37/47, 78.7%) than in group A (3/83, 3.6%; 1/83, 1.2%), respectively (P < 0.05). Convulsions with mild gastroenteritis (CwG) were statistically more significant in group A (50/83, 60.2%) than in group B (8/47, 17.0%) (P < 0.05). However, encephalitis/encephalopathy was statistically more significant in group B (20/47, 42.6%) than in group A (10/83, 12.0%) (P < 0.05). MRI showed cytotoxic edema in typical locations (RESLES type-1 limited to the splenium of the corpus callosum and RESLES type-2 spread to the entire corpus callosum, adjacent white matter, or both). There was full recovery of the lesions of MRI in all cases from 3 days to 50 days after the initial examinations. All the children showed normal neurodevelopment.

Conclusion: Infection was the most common cause of RESLES. Infections of the gastrointestinal tract are common in ≤ 3 years old children, while infections of the respiratory tract are common in >3 years old children. Younger patients are more likely to develop convulsions, and older children were more likely to have symptoms with disturbance of consciousness and headache/dizziness. RESLES has characteristic MRI manifestations and a good prognosis.

Keywords: children; convulsions; infection; magnetic resonance imaging; reversible splenial lesion syndrome.