Abstract
Aim: Among neurological diseases, the most common epileptic seizures in the form of transient visual impairment various types of magnetic resonance imaging, which can be and may be transient changes
can lead to diagnostic difficulties. One of these conditions is the Reversible Splenial Lesion (RESLES) syndrome in which the collosum splenium (CSS) is transiently affected. In this article, transient
short-term visual impairment a transient splenial lesion due to an epileptic seizure presenting with discussion of other diseases that may cause RESLES based on the case is intended.
Case: A twenty-six-year-old female patient admitted to the emergency department with the complaint of blurred vision/sightlessness in both eyes, which started in the morning and repeated 20-30 times, lasting for 5-6 seconds. In histroy, it was learned that she was on the twenty-fifth postpartum day and had a cesarean section with epidural anesthesia, and she did not use medication. Her medical and family history were unremarkable. In vital signs; blood pressure: 110/75 mmHg, pulse: 82 beats/min, respiratory rate: 14/min, fever: 36.5°C. Ophthalmological and neurological examination was normal when she had no visual complaints. Blood tests were normal. Brain tomography was normal. Diffusion MRI revealed a hyperintense lesion in B1000 in CKS and hypointense lesion in ADC. Contrast-enhanced carotid vertebral artery cranial CT angiography was performed in terms of dissection, and it was found to be normal. Electroencephalography performed for the etiology of epileptic seizures, slow waves lasting 4-5 seconds were observed at paroxysmal, generalized theta frequency. With the diagnosis of epileptic seizure, the patient was started on 1000 mg/day maintenance treatment after 1000 mg/day levetiracetam loading. The patient’s complaints improved after antiepileptic treatment and did not recur.
Conlusion: RESLES is a benign and temporary condition that can be encountered with many etiological reasons. It can happen even in a single epileptic seizure and can mimic many clinical cases. In order to ensure the patient reaches the right treatment without losing time, it is important to know and keep in mind the pre-diagnosis of RESLES in patients with a similar clinic, after excluding other emergency diagnosis. Considering that our case has a demonstrative aspect, it was deemed worthy to be presented.
References
- Doummar D, Roussat B, Pelosse B, et al. Management of acute visual loss in children. Arch Pediatr 2004; 11: 1384- 1388.
- da Silva AV, Neves MF, Parizotto C, Filho O, Koltermann T. Mild encephalitis with reversible splenial lesion and anti-NMDA receptor encephalitis. J Neurol Sci 2015.
- Starkey J, Kobayashi N, Numaguchi Y, et al. Cytotoxic lesions of the corpus callosum that show restricted diffusion: Mechanisms, causes, and manifestations. Radiographics 2017; 37(2): 562-576.
- Oster J, Doherty C, Grant PE, Simon M, Cole AJ. Diffusion-weighted imaging abnormalities in the splenium after seizures. Epilepsia 2003;44(6):852-4.
- Doherty MJ, Jayadev S, Watson NF, Konchada RS, Hallam DK. Clinical implications of splenium magnetic resonance imaging signal changes. Arch Neurol. 2005; 62: 433-437.
- Hufnagel A, Weber J, Marks S et al. Brain diffusion after single seizures. Epilepsia 2003;44(1):54-63.
- Senn P, Lövblad KO, Zutter D et al. Changes on diffusion-weighted MRI with focal motor status epilepticus: case report. Neuroradiology 2003;45(4):246-9.
- Krause KH, Rascher W, Berlit P. Plasma arginine vasopressin concentrations in epileptics under monotherapy. J Neurol 1983;230:193–6.
- Kim SS, Chang KH, Kim ST, et al. Focal lesion in the splenium of the corpus callosum in epileptic patients: antiepileptic drug toxicity? AJNR Am J Neuroradiol 1999;20(1):125–129.
- Karaarslan E, Ulus S, Kürtüncü M. Susceptibility-weighted imaging in migraine with aura. AJNR Am J Neuroradiol 2011;32(1):E5–E7.
- Jacob A, Mahavish K, Bowden A, Smith ET, Enevoldson P, White RP. Imaging abnormalities in sporadic hemiplegic migraine on conventional MRI, diffusion and perfusion MRI and MRS. Cep halalgia 2006;26(8):1004-9.
- Moriguchi T, Harii N, Goto J et. al. A First Case of Meningitis/Encephalitis Associated with SARSCoronavirus-2. Int J Infect Dis 2020;94:55–58.
Abstract
Amaç: Nörolojik hastalıklar arasında sık karşılaşılmamakla birlikte geçici görme bozukluğu şeklinde epileptik nöbet olabilir ve geçici olabilen çeşitli manyetik rezonans görüntüleme değişiklikleri tanı zorluğuna yol açabilir. Bu durumlardan biri de korpus kallozum spleniumunun (KSS) geçici olarak etkilendiği Reversibl Splenial Lezyon Sendromu (RESLES)'dur. Bu yazıda geçici kısa süreli görme bozukluğu ile prezente olan epileptik nöbete bağlı geçici splenial lezyon saptanan bir olgu üzerinden RESLES’e neden
olabilecek diğer hastalıkların tartışılması amaçlanmıştır.
Olgu: Yirmi altı yaşında kadın hasta, sabah saatlerinde başlayan ve 20-30 kez tekrarlayan, 5-6 saniye süren, her iki gözünde bulanık görme/görmeme şikayeti ile acil servise başvurdu. Geçmişinde doğum
sonrası yirmi beşinci günde olduğu, epidural anestezi ile sezaryen yaptığı ve ilaç kullanmadığı öğrenildi. Tıbbi ve aile öyküsünde özellik yoktu. Yaşamsal bulgularda; kan basıncı: 110/75 mmHg, nabız: 82 atım/dk, solunum sayısı: 14/dk, ateş: 36,5°C. Görme şikayeti olmayan hastanın oftalmolojik ve nörolojik muayenesi normaldi. Kan testleri normaldi. Beyin tomografisi normaldi. Difüzyon MR'da CKS'de B1000'de hiperintens, ADC'de ise hipointens lezyon saptandı. Diseksiyon açısından kontrastlı karotis vertebral arter kranyal BT anjiyografisi yapıldı ve normal olduğu görüldü. Epileptik nöbet etiyolojisine yönelik yapılanelektroensefalografide, paroksismal, jeneralize teta frekansında 4-5 saniye süren yavaş dalgalar gözlendi. Epileptik nöbet tanısıyla hastaya 1000 mg/gün levetirasetam yüklemesinin ardından 1000 mg/gün idame tedavisi başlandı. Antiepileptik tedavi sonrasında hastanın şikayetleri düzeldi ve tekrarlamadı.
Sonuç: RESLES bir çok etiyolojik nedenle karşılaşılabilen iyi huylu ve geçici bir durumdur. Tek epileptik nöbette dahi olabilir ve bir çok klinik tabloyu taklit edebilir. Acil servise benzer klinikle başvuran hastalarda diğer acil tanılar ekarte edildikten sonra, RESLES ön tanısının bilinmesi ve akılda tutulması hastanın doğru tedaviye zaman kaybetmeden ulaşmasını sağlaması açısından önemlidir. Olgumuzun bu nedenle demonstratif bir yönü olduğu düşünülerek, olgumuz sunulmaya değer görülmüştür
References
- Doummar D, Roussat B, Pelosse B, et al. Management of acute visual loss in children. Arch Pediatr 2004; 11: 1384- 1388.
- da Silva AV, Neves MF, Parizotto C, Filho O, Koltermann T. Mild encephalitis with reversible splenial lesion and anti-NMDA receptor encephalitis. J Neurol Sci 2015.
- Starkey J, Kobayashi N, Numaguchi Y, et al. Cytotoxic lesions of the corpus callosum that show restricted diffusion: Mechanisms, causes, and manifestations. Radiographics 2017; 37(2): 562-576.
- Oster J, Doherty C, Grant PE, Simon M, Cole AJ. Diffusion-weighted imaging abnormalities in the splenium after seizures. Epilepsia 2003;44(6):852-4.
- Doherty MJ, Jayadev S, Watson NF, Konchada RS, Hallam DK. Clinical implications of splenium magnetic resonance imaging signal changes. Arch Neurol. 2005; 62: 433-437.
- Hufnagel A, Weber J, Marks S et al. Brain diffusion after single seizures. Epilepsia 2003;44(1):54-63.
- Senn P, Lövblad KO, Zutter D et al. Changes on diffusion-weighted MRI with focal motor status epilepticus: case report. Neuroradiology 2003;45(4):246-9.
- Krause KH, Rascher W, Berlit P. Plasma arginine vasopressin concentrations in epileptics under monotherapy. J Neurol 1983;230:193–6.
- Kim SS, Chang KH, Kim ST, et al. Focal lesion in the splenium of the corpus callosum in epileptic patients: antiepileptic drug toxicity? AJNR Am J Neuroradiol 1999;20(1):125–129.
- Karaarslan E, Ulus S, Kürtüncü M. Susceptibility-weighted imaging in migraine with aura. AJNR Am J Neuroradiol 2011;32(1):E5–E7.
- Jacob A, Mahavish K, Bowden A, Smith ET, Enevoldson P, White RP. Imaging abnormalities in sporadic hemiplegic migraine on conventional MRI, diffusion and perfusion MRI and MRS. Cep halalgia 2006;26(8):1004-9.
- Moriguchi T, Harii N, Goto J et. al. A First Case of Meningitis/Encephalitis Associated with SARSCoronavirus-2. Int J Infect Dis 2020;94:55–58.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Case Report |
| Authors | |
| Early Pub Date | December 29, 2023 |
| Publication Date | December 29, 2023 |
| Published in Issue | Year 2023 Volume: 6 Issue: 4 |
