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A 19-year-old man developed a severe upper respiratory infection. His chest X-ray was normal and the infection was presumed to have been viral. One week after his respiratory symptoms had resolved, he developed numbness of his entire left side. He reported no weakness, headache, changes in vision, seizures or right-sided symptoms during this period. His MR scan of brain showed an isolated symmetrical, non-expansile lesion in the splenium of the corpus callosum, characterised by diffusion restriction (figure 1A, B) and fluid attenuated inversion recovery hyperintensity (figure 1C), but with no postcontrast enhancement (figure 1D).
Based on the MR scan findings he was referred for neurological evaluation. On examination, he reported subjective decreased sensation to light touch and pinprick in the left face and arm compared to the right, but objective testing of sensation was normal in all modalities, and the remainder of his neurological examination was entirely normal. The patient and referring provider were reassured that the neuroimaging finding was likely to be a benign sequela of his upper respiratory infection. On repeat MR imaging 15 days later, the lesion had completely resolved.
Discussion
The most extensive review of cases of reversible splenial lesion syndrome (RESLES) described associations most commonly with seizures, antiepileptic medications and their withdrawal and systemic and central nervous system infections.1 Other less frequently reported causes included high-altitude cerebral oedema, hypoglycaemia, hypernatraemia, systemic lupus erythematosus, malnutrition secondary to anorexia nervosa, vitamin B12 deficiency, methyl bromide exposure, Charcot–Marie–Tooth disease, Marchiafava–Bignami disease and exposure to sympathomimetic-containing diet pills, carboplatin, cisplatinum, 5-fluorouracil or the combination of olanzapine and citalopram.1
In this patient, the reversible radiological phenomenon was attributed to his severe viral respiratory infection. The most common systemic infective cause reported in association with RESLES is influenza, but other viruses (rotavirus, measles, human herpesvirus 6, Epstein–Barr virus, varicella zoster virus, mumps and adenovirus) and bacteria (Salmonella enteritidis, Escherichia coli and Legionella pneumophila) have also been reported.1
Neurologists should be aware of the differential diagnosis of symmetrical, diffusion-restricting splenial lesions in order to search for an underlying cause, or, if the cause is in the past, to reassure the patient and other providers that the lesion is usually benign and reversible.
Reference
Footnotes
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Graham Warner, Surrey, UK.
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