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Fujii R, Yamamoto R, Inoue Y, Fukuyo S, Yamaguchi T, Yoshimura R. An elderly man with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) without neuropsychiatric sequelae. Clin Case Rep 2023; 11:e7219. [PMID: 37151945 PMCID: PMC10160422 DOI: 10.1002/ccr3.7219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is less common in the elderly, and most have some sequelae. However, even in the elderly, MERS may have a good prognosis, and a specific treatment is not always required.
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Affiliation(s)
- Rintaro Fujii
- Department of Palliative Care and Hemato‐oncologyWakamatsu Hospital of the University of Occupational and Environmental HealthFukuokaJapan
- Department of PsychiatryUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Ryo Yamamoto
- Department of NeurologyWakamatsu Hospital of the University of Occupational and Environmental HealthFukuokaJapan
| | - Yoshino Inoue
- Department of Rheumatology and DiabetologyWakamatsu Hospital of the University of Occupational and Environmental HealthFukuokaJapan
| | - Shunsuke Fukuyo
- Department of Rheumatology and DiabetologyWakamatsu Hospital of the University of Occupational and Environmental HealthFukuokaJapan
| | - Takahiro Yamaguchi
- Department of Palliative Care and Hemato‐oncologyWakamatsu Hospital of the University of Occupational and Environmental HealthFukuokaJapan
| | - Reiji Yoshimura
- Department of PsychiatryUniversity of Occupational and Environmental HealthFukuokaJapan
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Abstract
A 58-year-old woman had disseminated intravascular coagulation (DIC) and septic shock caused by Japanese spotted fever (JSF). Following treatment with minocycline, her general condition gradually improved; however, her disorientation persisted. Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) type II was diagnosed based on brain magnetic resonance imaging (MRI) showing a hyperintense area in the splenium of the corpus callosum and bilateral cerebral white matter on diffusion-weighted imaging. Thereafter, her consciousness gradually improved, but she continued to experience difficulty concentrating and attention deficits. MERS type II may take longer to improve than type I, and long-term follow-up is required.
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Affiliation(s)
- Emi Tanaka
- Department of Internal Medicine, Fukuyama City Hospital, Japan
| | - Naohiro Oda
- Department of Internal Medicine, Fukuyama City Hospital, Japan
| | - Shigeru Ota
- Department of Internal Medicine, Fuji Hospital, Japan
| | - Toru Ueki
- Department of Internal Medicine, Fukuyama City Hospital, Japan
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Yıldırım Z, Timer SM, Çelik D, Karademir F, Kale N. Mild Encephalitis/Encephalopathy with a Reversible Lesion in The Splenium. Noro Psikiyatr Ars 2023; 60:90-96. [PMID: 36911559 PMCID: PMC9999219 DOI: 10.29399/npa.27961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/28/2021] [Indexed: 11/07/2022] Open
Abstract
Mild encephalitis/encephalopathy with a reversible lesion in the splenium (MERS) is a clinico-radiological syndrome with mild central nervous system symptoms and a reversible lesion in the splenium of the corpus callosum. It is mainly associated with a number of viral and bacterial infections, including Coronavirus disease 2019 (COVID-19). In this paper, we report four MERS patients. One had a mumps infection, the second had aseptic meningitis, the third had Marchiafava-Bignami disease, and the fourth had atypical pneumonia associated with COVID-19 infection.
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Affiliation(s)
- Zerrin Yıldırım
- İstanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Neuroscience, İstanbul, Turkey.,Bağcılar Training and Research Hospital, Department of Neurology, İstanbul, Turkey
| | | | - Didem Çelik
- Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Department of Neurology, İstanbul, Turkey
| | - Fazilet Karademir
- Bağcılar Training and Research Hospital, Department of Neurology, İstanbul, Turkey
| | - Nilüfer Kale
- Bağcılar Training and Research Hospital, Department of Neurology, İstanbul, Turkey
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Satake T, Maruki Y, Kubo Y, Takahashi M, Ohba A, Nagashio Y, Kondo S, Hijioka S, Morizane C, Ueno H, Okusaka T. Atezolizumab-induced Encephalitis in a Patient with Hepatocellular Carcinoma: A Case Report and Literature Review. Intern Med 2022; 61:2619-2623. [PMID: 35185051 PMCID: PMC9492495 DOI: 10.2169/internalmedicine.8919-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We herein report a case of encephalitis in a 42-year-old woman with hepatocellular carcinoma following atezolizumab plus bevacizumab therapy. After two weeks of treatment, she was admitted for a high fever, impaired consciousness, and convulsive seizure refractory to diazepam. Magnetic resonance imaging revealed a hyperintense splenial lesion. A cerebrospinal fluid test excluded malignancy and infection. These findings were highly suggestive of a diagnosis of encephalitis due to atezolizumab, an immune-related adverse event. Steroid pulse therapy improved the fever and seizure. However, her incomplete right-sided paralysis and aphasia persisted. This is the first case report of encephalitis caused by atezolizumab plus bevacizumab therapy for hepatocellular carcinoma.
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Affiliation(s)
- Tomoyuki Satake
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Japan
| | - Yuta Maruki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Japan
| | - Yuko Kubo
- Department of Diagnostic Radiology, National Cancer Center Hospital, Japan
| | - Masamichi Takahashi
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Japan
| | - Akihiro Ohba
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Japan
| | - Yoshikuni Nagashio
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Japan
| | - Shunsuke Kondo
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Japan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Japan
| | - Chigusa Morizane
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Japan
| | - Hideki Ueno
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Japan
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Shi BC, Li J, Jiang JW, Li MX, Zhang J, Shang XL. Mild encephalitis/encephalopathy with a reversible splenial lesion secondary to encephalitis complicated by hyponatremia: A case report and literature review. Medicine (Baltimore) 2019; 98:e17982. [PMID: 31764808 PMCID: PMC6882656 DOI: 10.1097/md.0000000000017982] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is an infection-associated encephalitis/encephalopathy syndrome that is predominately caused by a virus. MERS has no direct association with central nervous system (CNS) infections or inflammation. Non-CNS infections may cause reversible lesion in the splenium of corpus callosum. Recently, there have been reports of many patients with hyponatremia related MERS. Interleukin-6 (IL-6) was also found elevated in serum and in cerebrospinal fluid (CSF) in patients with MERS. The role of IL-6 in the non-osmotic release of vasopressin is crucial. Persistent hyponatremia may be linked to this effect. The following is a case report of MERS secondary to encephalitis, complicated by hyponatremia. We will summarize the latest research and progress regarding MERS. PATIENT CONCERNS A 31-year-old man was admitted to our department with a 5-day history of fever and headache. His initial diagnosis was encephalitis and hyponatremia; during this period the patient also developed MERS secondary to the encephalitis. DIAGNOSES Encephalitis was diagnosed by reviewing the history of fever, headache, neck rigidity and Kerning sign (+) on clinical examination. Lab tests revealed: serum VCA IgG (+), EBNA-1 IgG (-), EBV IgM (-), and inflammation in the analysis of CSF. Cranial MRI+C showed that the blood vessels on the surface of the brain were obviously increasing and thickening and diffuse slow waves were detected on the electroencephalogram (EEG). The patient's hyponatremia aggravated on the third day of hospitalization. On the fourth day of hospitalization, the patient was somnolent, apathetic, and slow. Magnetic resonance imaging (MRI) of the brain, with a T2-weighted fluid attenuated inversion recovery image, showed high-signal intensity in the splenium of the corpus callosum (SCC) on the fifth day of hospitalization. Diffusion-weighted imaging (DWI) showed splenial hyperintensity as a "boomerang sign" and reduced diffusion on apparent diffusion coefficient (ADC) maps. Cranial MRI findings returned to normal after 1 month. The diagnosis of MERS was confirmed. INTERVENTIONS We administered an intravenous drip infusion of acyclovir and prescribed oral sodium supplementation. OUTCOMES The patient's neurological symptoms gradually improved. The MRI lesion in the SCC disappeared on the 30th day. LESSONS In patients with encephalitis accompanied by hyponatremia, elevated IL-6 or urinary β2-microglobulin (β2MG), and exacerbations such as sudden somnolence, delirium, confusion, and seizures, the possibility of secondary MERS should be investigated, in addition to the progression of encephalitis.
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Abstract
Two patients who showed transient lesions in the splenium of the corpus callosum (SCC) secondary to acute ischemic stroke are reported. Both patients had embolic strokes and showed an isolated lesion in the SCC on magnetic resonance imaging (MRI) 1-2 weeks after the onset of stroke, with a hyperintense lesion on diffusion-weighted imaging and decreased apparent diffusion coefficient values, with no symptoms related to the lesion. In both cases, the lesion disappeared on MRI approximately 1 week later. Clinicians should note that transient SCC lesions can occur following acute ischemic stroke and avoid misdiagnosing them and performing unnecessary examinations or treatment.
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Affiliation(s)
- Yoshitaka Yamaguchi
- Department of Neurology, Yamagata Prefectural Central Hospital, Japan
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Yuko Iwasaki
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Manabu Wada
- Department of Neurology, Yamagata Prefectural Central Hospital, Japan
| | - Naoki Makita
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Hikaru Nagasawa
- Department of Neurology, Yamagata Prefectural Central Hospital, Japan
| | - Tatsushi Yamakawa
- Department of Neurology, Yamagata Prefectural Central Hospital, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Japan
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Nagamura N, Higuchi H. Segmental Arterial Mediolysis with Preceding Symptoms Resembling Viral Infection Hampers the Differentiation from Polyarteritis Nodosa. Intern Med 2019; 58:2721-2726. [PMID: 31527370 PMCID: PMC6794176 DOI: 10.2169/internalmedicine.2487-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A middle-aged man presented with a fever, arthralgia, gastrointestinal symptoms, headache, and rash. After two weeks, the patient suddenly complained of severe abdominal pain, and computed tomography revealed aneurysms in the hepatic and splenic arteries, which increased in size progressively. Given the elevated levels of inflammatory markers and orchitis, polyarteritis nodosa (PN) was initially suspected. Catheter embolization for the ruptured hepatic aneurysm and splenectomy for the large splenic ones were performed, and the pathological finding was consistent with segmental arterial mediolysis (SAM). Changes in inflammatory marker levels and aneurysmal size are also informative to differentiate SAM from PN.
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Affiliation(s)
- Norihiro Nagamura
- Department of Rheumatology and Allergology, Shimane Prefectural Central Hospital, Japan
| | - Hiroshi Higuchi
- Department of General Medicine, Shimane Prefectural Central Hospital, Japan
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Imataka G, Yamaguchi T, Ishii J, Ogino K, Okamoto K, Tsuchioka T, Yoshihara S. MERS associated with bacterial translocation in a pediatric patient with congenital portal vein hypoplasia: A case report. Exp Ther Med 2018; 16:2831-2834. [PMID: 30214504 PMCID: PMC6125833 DOI: 10.3892/etm.2018.6532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/08/2017] [Indexed: 11/21/2022] Open
Abstract
A case of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in a female child who developed bacterial translocation from a congenital portal vein hypoplasia is reported. The patient was diagnosed as having portal hypertension after examinations and laboratory results showing splenomegaly and thrombocytopenia at the age of 1 year. The patient required three endoscopic variceal ligation (EVL) surgeries before the age of 9 due to development of multiple esophageal varices. After the second and third EVL procedures, she developed septicemia, possibly due to bacterial translocation associated with the administration of general anesthesia. The day after the third EVL, the patient presented with high fever and neurological disturbances (altered consciousness). Magnetic resonance imaging detected abnormal intensities in the corpus callosum ampulla and cerebral white matter, which suggested a diagnosis of MERS type 2. Considering this clinical course, the possible association between bacterial translocation and MERS in a patient with congenital portal vein hypoplasia and portal hypertension is discussed.
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Affiliation(s)
- George Imataka
- Department of Pediatrics, Dokkyo Medical University, Shimotsuga, Tochigi 321-0293, Japan
| | - Takeshi Yamaguchi
- Department of First Surgery, Dokkyo Medical University, Shimotsuga, Tochigi 321-0293, Japan
| | - Junpei Ishii
- Department of Pediatrics, Dokkyo Medical University, Shimotsuga, Tochigi 321-0293, Japan
| | - Kei Ogino
- Department of First Surgery, Dokkyo Medical University, Shimotsuga, Tochigi 321-0293, Japan
| | - Kentaro Okamoto
- Department of First Surgery, Dokkyo Medical University, Shimotsuga, Tochigi 321-0293, Japan.,Department of Pediatric Surgery, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Takashi Tsuchioka
- Department of First Surgery, Dokkyo Medical University, Shimotsuga, Tochigi 321-0293, Japan
| | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University, Shimotsuga, Tochigi 321-0293, Japan
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Xu J, Gao F, Yuan Z, Jiang L, Xia Z, Zhao Z. Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) associated with bacteria meningitis caused by listeria monocytogenes: A case report. Medicine (Baltimore) 2018; 97:e11561. [PMID: 30045281 PMCID: PMC6078722 DOI: 10.1097/md.0000000000011561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Mild encephalitis/encephalopathy with a reversible splenial lesion is a clinico-radiological syndrome mainly triggered by viral infection. Bacteria, like listeria monocytogenes, are relatively rare pathogens. PATIENT CONCERNS A two and a half years old girl with a 3-day history of fever and vomiting, complicated by a sudden seizure. She was in a coma after seizure. DIAGNOSES Listeria monocytogenes was detected in cerebrospinal fluid cultures. Serum IL-6 remarkably elevated, and hyponatremia appeared on day 2 of hospitalization. Magnetic resonance imaging of the brain performed on day 3 of hospitalization showed right subdural effusion and a lesion in the central portion of the splenium of the corpus callosum. INTERVENTIONS We administered antimicrobial therapy, intravenous mannitol and hypertonic fluid therapy. OUTCOMES Her neurological symptoms improved gradually. The lesion in the splenium of the corpus callosum completely disappeared on magnetic resonance imaging on day 10 of hospitalization. LESSONS We diagnosed this case as mild encephalitis/encephalopathy with a reversible splenial lesion caused by listeria monocytogenes. The patient recovered completely clinically and on imaging, without any specific immunomodulatory treatment. It also indicated IL-6 may play a role in the forms of hyponatremia in mild encephalitis/encephalopathy with a reversible splenial lesion.
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Abstract
We herein report the case of a 31-year-old Japanese woman who developed adult-onset clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) and presented with consciousness disorder and olfactory disturbance secondary to influenza A infection. The patient's neurological symptoms and the lesion in the splenium resolved within 14 days without therapy. Magnetic resonance images and the clinical course were consistent with a diagnosis of MERS; however, mental changes following the influenza infection always present a diagnostic dilemma for physicians. We considered various diagnoses, including viral encephalitis, medication-related encephalopathy, and MERS. A comprehensive assessment may be required to diagnose MERS, since it may mimic other neurological diseases, such as viral encephalitis and medication-related encephalopathy.
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Affiliation(s)
- Hana Takatsu
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Naoto Ishimaru
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Madoka Ito
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Saori Kinami
- Department of General Internal Medicine, Akashi Medical Center, Japan
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Liu Y, Li GM, Li SH, Wang XQ, Li SR, Zhang J, Wang HF, Pang BD, Wu JH. [Clinical features of mild encephalitis/encephalopathy with a reversible splenial lesion in children]. Zhongguo Dang Dai Er Ke Za Zhi 2016; 18:1291-1295. [PMID: 27974125 PMCID: PMC7403080 DOI: 10.7499/j.issn.1008-8830.2016.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the clinical features of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in children. METHODS The clinical data of 8 children with MERS were retrospectively analyzed. RESULTS The mean age of onset was 5 years and 2 months (range 10 months to 12 years). The major clinical features included a history of prodromal infection, and among these children, 5 had pyrexia and 4 had vomiting. Of all the children, 6 were manifested as convulsion and 3 each were manifested as disturbance of consciousness and paroxysmal paropsia. Cranial diffusion-weighted magnetic resonance imaging (MRI) showed high signals in the splenium of the corpus callosum. Among these children, one child had symmetric and multiple long T1 and long T2 signals in the bilateral centrum semiovale and part of the temporal white matter. MRI reexamination performed after 5-30 days showed the disappearance of abnormal signals in all the children. The children were followed up for 3 months to 2 years, and no child experienced abnormal neurodevelopment. CONCLUSIONS The development of MERS in children is closely associated with infection. MERS is characterized by high signals in the splenium of the corpus callosum on cranial diffusion-weighted MRI. Most children have good prognosis.
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Affiliation(s)
- Yin Liu
- Department of Pediatrics, Maternity and Children's Hospital, Tangshan, Hebei 063000, China.
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