Clinical Feature And Prognostic Analysis Of Reversible Splenial Lesion In Children

Objective:To explore the clinical characteristics of children with reversible splenial lesion syndrome(RESLES)and the relevant prognostic factors.Methods:The clinical data of 23 cases with RESLES admitted to Children Hospital of Chongqing medical university from January 2016 to February 2021 were retrospectively analyzed and summarized.All the enrolled patients were followed up at least 3 months.Results:The cohort consisted of 5 boys and 18 girls.The mean onset age was 4.85years(0.41 to 14.17).The causes included intracranial infection(n=12,52.17%),febrile convulsion(n=2,8.70%),epilepsy(n=2,8.70%),hypoglycemia(n=1,4.35%),hypoparathyroidism(n=1,4.35%),unknown causes(n=5,21.74%).12 cases(52.17%)were identified to have concomitantly definitive infection which comprised rotavirus(n=5,21.74%),EB virus(n=3,13.04%),measles virus(n=1,4.35%),mycoplasma(n=1,4.35%)and mixed infection(n=2,8.70%).The most common neurological manifestation in this cohort was seizures(n=20,86.96%),followed by dizziness(n=5,21.74%),headache(n=4,17.39%),conscious disturbance(n=4,17.39%)and limb paralysis(n=4,17.39%).The electroencephalogram findings of 10 cases were abnormal presenting diffuse slow waves(n=7),focal slow waves(n=1)and intracranial epileptic discharges(n=5).The other laboratory tests showed almost normal or non-specific changes.There were 18 cases categorized with type-I(78.26%)and 5 cases with type-II(21.74%),according to the records of MRI.All the cases showed good responses to the syndromic treatments including antiviral drugs,antibiotics,hormones,propylene globulins,antiepileptic drug and mannitol.And most of them were recovered completely.The lesions in MRI of 21 cases(91.30%)were completely disappeared,while the remaining 2 cases(8.70%)almost disappeared from day 6 to day 361 after the onset.At the end of follow-up(3-62 months),18 children(78.26%)were defined as favorable prognosis according to m RS and the other 5 children(21.74%)were in poor prognosis.Epileptic seizures,speech impairment,movement disorder represent the most frequent residual symptoms in the group with poor prognosis.Comparing to the poor prognosis group,the good prognosis group had significantly higher level of CK-MB.Conclusion:Children with RESLES often have prodromal infection and acute encephalopathy as clinical manifestations.Most patients have a good prognosis,of which increased level of CK-MB might be a predictive factor.