Hospital: Complejo Asistencial Universitario de Salamanca.
Aut@r o Autores: D. Vargas Jiménez, M. Garzón Guiteria, M. Ibarra Hernández, A. Pantiru, M. Maciá Fernández, C. González Donadeo.
We report a case of an 11-year-old girl without relevant medical history, with a complaint of two days of fever, arthralgia, headache, vomiting and diarrhea. Subsequently, she presented diplopia, nominal aphasia and unstable gait. During the hospitalization, a non-contrast CT (NCCT) and several analytical tests were performed, the scan and CSF bacterial culture was negative, viral polymerase chain reactions (PCR) for Herpes simplex, Varicella Zoster Virus and Enterovirus also showed no remarkable findings. Cerebral magnetic resonance imaging (MRI) was performed, showing an oval, circumscribed with welldefined borders lesion, located in the splenium of the corpus callosum (SCC) this lesion appears hypointense on T1W1, hyperintense on T2WI, FLAIR and DWI and showed true diffusion restriction in ADC map. Symptoms disappeared completely at 4 weeks. An control MRI was performed at 8 weeks showing complete resolution of the previous radiological findings.
Mild encephalopathy with a reversible SCC lesion is a clinical and radiological syndrome characterized by a transient encephalopathy and MRI findings of a reversible lesion in the SCC. The syndrome mainly affects children and young adults, the prognosis is favorable with neurological and radiological resolution. The exact pathophysiology is unknown, however, the infections remain the most common cause of reversible SCC lesions in childhood. MRI is the imaging modality of choice as these lesions are not seen on routine NCCT scan. MRI examination of the SCC demonstrate the lesions with reversible signal intensity, typical features includes T2WI-FLAIR high signal and restricted diffusion. The syndrome is classified into two types, type I, if SCC is affected and type II included changes in SCC and other white matter.
Mild encephalopathy with a reversible SCC lesions, is a good prognosis disease with typical findings in the MRI, it’s necessary to demonstrate the reversibility of this findings. Differential diagnoses like infections, ischemia, diffuse axonal injury, multiple sclerosis, metabolic diseases, should be included.
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