Reversible splenial lesion syndrome associated with SARS-CoV-2 infection in two children

Abstract

Background: Reversible splenial lesion syndrome (RESLES) is characterized by a temporary lesion in the splenium of the corpus callosum, emerging related to encephalitis, seizures, antiepileptic drug withdrawal, or metabolic disturbances. Among RESLES, mild encephalitis/encephalopathy with reversible splenial lesion (MERS) has been defined as a distinct clinicoradiologic syndrome associated with viral infections.

Case presentation: We report two children with multisystem inflammatory syndrome-children related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed RESLES during the disease course. Encephalopathy was the main central nervous system symptom. Both of the children showed a rapid recovery, and brain magnetic resonance imaging revealed complete resolution of the splenial lesion within 1 week.

Conclusion: The complete resolution of the splenial lesion and rapid recovery from encephalopathy in RESLES associated with SARS CoV-2 were similar to observed in MERS.

Keywords: Child; Coronavirus; Corpus callosum; Encephalitis.

Fig. 1

Brain magnetic resonance imaging of children. T2-weighted axial (A), sagital (B), diffusion-weighted image (C), and apparent diffusion coefficient (D) images of patient 1 show hyperintensity and restricted diffusion in the splenium of the corpus callosum. T2-weighted axial (E), sagital (F), and diffusion-weighted image (G), and apparent diffusion coefficient (H) images of patient 2 reveal hyperintensity and restricted diffusion in the splenium of the corpus callosum.