Department of Pediatrics, Hirakata City Hospital, Osaka, Japan.
Department of Child Neurology, Tanabe Children's Clinic, Osaka, Japan.
Brain Dev. 2021 Jun;43(6):698-704. doi: 10.1016/j.braindev.2021.02.004. Epub 2021 Mar 11.
Reversible splenium lesions during febrile illness (RESLEF) are found in a spectrum. There are two types of corpus callosum (CC) lesions: CC-only type, with limited lesions and the CC (+) type, with extensive white-matter lesions. This retrospective study aimed to describe the differences in clinical findings between CC-only and CC (+) lesions and the association between onset age and clinico-radiological features in RESLEF.
Fifty-two episodes of CC-only or CC (+) lesions accompanied by neurological symptoms, e.g., seizures, delirious behavior (DB), and disturbance of consciousness (DC), from January 2008 to October 2019 were included. We analyzed the etiology (pathogen), clinical course, laboratory data, magnetic resonance imaging and electroencephalography findings, therapy, and prognosis.
The rate of DC in the CC (+) was significantly higher than that in the CC-only group (5/6 [83%] vs 7/46 [15%]; p = 0.0016). The median number of seizures in the CC (+) was also significantly higher than that in the CC-only group (4 [0-7] vs 0 [0-7]; p = 0.034). Further, in RESLEF, the median onset age (months) in the seizure was significantly lower than that in the no-seizure group (39 [12-74] vs 83 [28-174]; p = 0.0007). The median onset age (months) in the DB was significantly higher than that in the no-DB group (74.5 [26-174] vs 28 [12-139]; p = 0.003).
In RESLEF, CC (+) is a more severe neurological symptom than CC-only. Furthermore, the onset age is related to the type of neurological symptoms that appear.
发热性疾病期间可逆性胼胝体压部病变（RESLEF）呈谱性分布。胼胝体（CC）病变有两种类型：CC 仅受累型，病变局限；CC（+）型，广泛白质病变。本回顾性研究旨在描述 CC 仅受累型和 CC（+）病变之间的临床差异，以及 RESLEF 发病年龄与临床-放射学特征的关系。
纳入 2008 年 1 月至 2019 年 10 月期间伴有神经症状（如癫痫发作、谵妄行为（DB）和意识障碍（DC））的 52 例 CC 仅受累或 CC（+）病变的病例。我们分析了病因（病原体）、临床病程、实验室数据、磁共振成像和脑电图表现、治疗和预后。
CC（+）组 DC 的发生率明显高于 CC 仅受累组（5/6 [83%] 比 7/46 [15%]；p=0.0016）。CC（+）组癫痫发作的中位数也明显高于 CC 仅受累组（4 [0-7] 比 0 [0-7]；p=0.034）。此外，在 RESLEF 中，癫痫发作的中位发病年龄（月）明显低于无癫痫发作组（39 [12-74] 比 83 [28-174]；p=0.0007）。DB 的中位发病年龄（月）明显高于无 DB 组（74.5 [26-174] 比 28 [12-139]；p=0.003）。
在 RESLEF 中，CC（+）比 CC 仅受累更严重的神经症状。此外，发病年龄与出现的神经症状类型有关。
