Reversible splenial lesion syndrome in children with benign convulsions associated with mild gastroenteritis: A retrospective study of five cases.

OBJECTIVE

To assess the clinical and imaging features of reversible splenial lesion syndrome (RESLES) with benign convulsions associated with mild gastroenteritis (CwG) in children.

METHODS

We retrospectively reviewed the clinical course, blood and stool examinations, cerebrospinal fluid (CSF) examination, magnetic resonance imaging (MRI), electroencephalography (EEG) findings, therapy and prognosis of five children with RESLES associated with CwG.

RESULTS

Five previously healthy patients, four girls and one boy, with mean age 26.4 ± 8.1 months, had clusters of general tonic-clonic or clonic seizures within the first two days of gastroenteritis. Rotavirus antigen was positive in the stool of one case. Interictal EEG was normal except in one case, which showed occipital slow wave. The initial MRI was performed within five days of onset, four patients had an isolated lesion in the splenium of the corpus callosum (SCC), and one patient had lesions extending outside the SCC that involved the genu of the corpus callosum. The follow-up MRI was performed 10-15 days after onset, and all lesions had completely disappeared. All patients were treated with antiviral, rehydration and anticonvulsant therapy in the acute phase. They had good prognosis and normal psychomotor development, with no neurological sequelae after 26-30 months of follow-up.

CONCLUSIONS

CwG and RESLES can coexist in young children. The patients present with clusters of general tonic-clonic or clonic seizures in the acute phase. Brain MRI shows focal lesion in the SCC with high signal intensity on T2-weighted and FLAIR sequences. It has good prognosis and excessive treatment is not necessary.