Reversible splenial lesion syndrome: an analysis of four cases

Abstract

Objective To investigate the clinical and imaging characteristics and to describe the etiology and possible pathophysiological mechanisms of reversible splenial lesion syndrome (RESLES). Methods Clinical, radiological data and etiology of 4 cases with RESLES were retrospectively analyzed. Results Two (Case 1 and Case 2) of the 4 patients were caused by traumatic brain injury (TBI), one (Case 3) presented paroxysmal blurred vision after drinking, and the last one (Case 4) suffered from headache and syncope, intermittent blurred vision and chronic renal failure after cold. Cerebral MRI of all patients revealed solitary round lesions with clear boundary in the splenial of corpus callosum, which had isointensity or slightly low - intensity T1WI signal, high - intensity signal in T2WI, FLAIR and diffusion - weighted imaging (DWI), low-intensity signal of apparent diffusion coefficient (ADC), without edema and mass effect. Susceptility-weighted imaging (SWI) revealed frontal hemorrhage in one case (Case 2) expect for splenial lesion. After etiological and symptomatic treatment, the patients were all relieved, with duration for 8-15 d. MRI reexamination showed abnormal signals of corpus callosum disappeared in 3 patients, and were improved in the other case (Case 2). Neurologic sequelae was not found. Conclusions RESLES is a kind of clinical imaging syndrome with a wide variety of etiologies. One of the most common causes is epilepsy and related disease. Trauma may also be one of the etiologies. The most common clinical manifestations of RESLES are nonspecific, and the prognosis is good after etiological treatment.

DOI: 10.3969/j.issn.1672-6731.2018.07.012