Mild encephalitis/encephalopathy with a reversible splenial lesion secondary to encephalitis complicated by hyponatremia
Identifieur interne : 000774 ( Pmc/Curation ); précédent : 000773; suivant : 000775Mild encephalitis/encephalopathy with a reversible splenial lesion secondary to encephalitis complicated by hyponatremia
Auteurs : Bi-Chuan Shi ; Jiao Li ; Ji-Wei Jiang ; Mei-Xin Li ; Jian Zhang ; Xiu-Li ShangSource :
- Medicine [ 0025-7974 ] ; 2019.
Abstract
Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is an infection-associated encephalitis/encephalopathy syndrome that is predominately caused by a virus. MERS has no direct association with central nervous system (CNS) infections or inflammation. Non-CNS infections may cause reversible lesion in the splenium of corpus callosum. Recently, there have been reports of many patients with hyponatremia related MERS. Interleukin-6 (IL-6) was also found elevated in serum and in cerebrospinal fluid (CSF) in patients with MERS. The role of IL-6 in the non-osmotic release of vasopressin is crucial. Persistent hyponatremia may be linked to this effect. The following is a case report of MERS secondary to encephalitis, complicated by hyponatremia. We will summarize the latest research and progress regarding MERS.
A 31-year-old man was admitted to our department with a 5-day history of fever and headache. His initial diagnosis was encephalitis and hyponatremia; during this period the patient also developed MERS secondary to the encephalitis.
Encephalitis was diagnosed by reviewing the history of fever, headache, neck rigidity and Kerning sign (+) on clinical examination. Lab tests revealed: serum VCA IgG (+), EBNA-1 IgG (−), EBV IgM (−), and inflammation in the analysis of CSF. Cranial MRI+C showed that the blood vessels on the surface of the brain were obviously increasing and thickening and diffuse slow waves were detected on the electroencephalogram (EEG). The patient's hyponatremia aggravated on the third day of hospitalization. On the fourth day of hospitalization, the patient was somnolent, apathetic, and slow. Magnetic resonance imaging (MRI) of the brain, with a T2-weighted fluid attenuated inversion recovery image, showed high-signal intensity in the splenium of the corpus callosum (SCC) on the fifth day of hospitalization. Diffusion-weighted imaging (DWI) showed splenial hyperintensity as a “boomerang sign” and reduced diffusion on apparent diffusion coefficient (ADC) maps. Cranial MRI findings returned to normal after 1 month. The diagnosis of MERS was confirmed.
We administered an intravenous drip infusion of acyclovir and prescribed oral sodium supplementation.
The patient's neurological symptoms gradually improved. The MRI lesion in the SCC disappeared on the 30th day.
In patients with encephalitis accompanied by hyponatremia, elevated IL-6 or urinary β2-microglobulin (β2MG), and exacerbations such as sudden somnolence, delirium, confusion, and seizures, the possibility of secondary MERS should be investigated, in addition to the progression of encephalitis.
Url:
DOI: 10.1097/MD.0000000000017982
PubMed: 31764808
PubMed Central: 6882656
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Mild encephalitis/encephalopathy with a reversible splenial lesion secondary to encephalitis complicated by hyponatremia</title><author><name sortKey="Shi, Bi Chuan" sort="Shi, Bi Chuan" uniqKey="Shi B" first="Bi-Chuan" last="Shi">Bi-Chuan Shi</name></author><author><name sortKey="Li, Jiao" sort="Li, Jiao" uniqKey="Li J" first="Jiao" last="Li">Jiao Li</name></author><author><name sortKey="Jiang, Ji Wei" sort="Jiang, Ji Wei" uniqKey="Jiang J" first="Ji-Wei" last="Jiang">Ji-Wei Jiang</name></author><author><name sortKey="Li, Mei Xin" sort="Li, Mei Xin" uniqKey="Li M" first="Mei-Xin" last="Li">Mei-Xin Li</name></author><author><name sortKey="Zhang, Jian" sort="Zhang, Jian" uniqKey="Zhang J" first="Jian" last="Zhang">Jian Zhang</name></author><author><name sortKey="Shang, Xiu Li" sort="Shang, Xiu Li" uniqKey="Shang X" first="Xiu-Li" last="Shang">Xiu-Li Shang</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">31764808</idno><idno type="pmc">6882656</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882656</idno><idno type="RBID">PMC:6882656</idno><idno type="doi">10.1097/MD.0000000000017982</idno><date when="2019">2019</date><idno type="wicri:Area/Pmc/Corpus">000774</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000774</idno><idno type="wicri:Area/Pmc/Curation">000774</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000774</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Mild encephalitis/encephalopathy with a reversible splenial lesion secondary to encephalitis complicated by hyponatremia</title><author><name sortKey="Shi, Bi Chuan" sort="Shi, Bi Chuan" uniqKey="Shi B" first="Bi-Chuan" last="Shi">Bi-Chuan Shi</name></author><author><name sortKey="Li, Jiao" sort="Li, Jiao" uniqKey="Li J" first="Jiao" last="Li">Jiao Li</name></author><author><name sortKey="Jiang, Ji Wei" sort="Jiang, Ji Wei" uniqKey="Jiang J" first="Ji-Wei" last="Jiang">Ji-Wei Jiang</name></author><author><name sortKey="Li, Mei Xin" sort="Li, Mei Xin" uniqKey="Li M" first="Mei-Xin" last="Li">Mei-Xin Li</name></author><author><name sortKey="Zhang, Jian" sort="Zhang, Jian" uniqKey="Zhang J" first="Jian" last="Zhang">Jian Zhang</name></author><author><name sortKey="Shang, Xiu Li" sort="Shang, Xiu Li" uniqKey="Shang X" first="Xiu-Li" last="Shang">Xiu-Li Shang</name></author></analytic><series><title level="j">Medicine</title><idno type="ISSN">0025-7974</idno><idno type="eISSN">1536-5964</idno><imprint><date when="2019">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><sec><title>Rationale:</title><p>Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is an infection-associated encephalitis/encephalopathy syndrome that is predominately caused by a virus. MERS has no direct association with central nervous system (CNS) infections or inflammation. Non-CNS infections may cause reversible lesion in the splenium of corpus callosum. Recently, there have been reports of many patients with hyponatremia related MERS. Interleukin-6 (IL-6) was also found elevated in serum and in cerebrospinal fluid (CSF) in patients with MERS. The role of IL-6 in the non-osmotic release of vasopressin is crucial. Persistent hyponatremia may be linked to this effect. The following is a case report of MERS secondary to encephalitis, complicated by hyponatremia. We will summarize the latest research and progress regarding MERS.</p></sec><sec><title>Patient concerns:</title><p>A 31-year-old man was admitted to our department with a 5-day history of fever and headache. His initial diagnosis was encephalitis and hyponatremia; during this period the patient also developed MERS secondary to the encephalitis.</p></sec><sec><title>Diagnoses:</title><p>Encephalitis was diagnosed by reviewing the history of fever, headache, neck rigidity and Kerning sign (+) on clinical examination. Lab tests revealed: serum VCA IgG (+), EBNA-1 IgG (−), EBV IgM (−), and inflammation in the analysis of CSF. Cranial MRI+C showed that the blood vessels on the surface of the brain were obviously increasing and thickening and diffuse slow waves were detected on the electroencephalogram (EEG). The patient's hyponatremia aggravated on the third day of hospitalization. On the fourth day of hospitalization, the patient was somnolent, apathetic, and slow. Magnetic resonance imaging (MRI) of the brain, with a T2-weighted fluid attenuated inversion recovery image, showed high-signal intensity in the splenium of the corpus callosum (SCC) on the fifth day of hospitalization. Diffusion-weighted imaging (DWI) showed splenial hyperintensity as a “boomerang sign” and reduced diffusion on apparent diffusion coefficient (ADC) maps. Cranial MRI findings returned to normal after 1 month. The diagnosis of MERS was confirmed.</p></sec><sec><title>Interventions:</title><p>We administered an intravenous drip infusion of acyclovir and prescribed oral sodium supplementation.</p></sec><sec><title>Outcomes:</title><p>The patient's neurological symptoms gradually improved. The MRI lesion in the SCC disappeared on the 30th day.</p></sec><sec><title>Lessons:</title><p>In patients with encephalitis accompanied by hyponatremia, elevated IL-6 or urinary β2-microglobulin (β2MG), and exacerbations such as sudden somnolence, delirium, confusion, and seizures, the possibility of secondary MERS should be investigated, in addition to the progression of encephalitis.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Carlos Garcia Monco, J" uniqKey="Carlos Garcia Monco J">J Carlos Garcia-Monco</name></author><author><name sortKey="Escalza Cortina, I" uniqKey="Escalza Cortina I">I Escalza Cortina</name></author><author><name sortKey="Ferreira, E" uniqKey="Ferreira E">E Ferreira</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tada, H" uniqKey="Tada H">H Tada</name></author><author><name sortKey="Takanashi, J" uniqKey="Takanashi J">J Takanashi</name></author><author><name 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Medicine (Baltimore)</journal-id><journal-id journal-id-type="iso-abbrev">Medicine (Baltimore)</journal-id><journal-id journal-id-type="publisher-id">MEDI</journal-id><journal-title-group><journal-title>Medicine</journal-title></journal-title-group><issn pub-type="ppub">0025-7974</issn><issn pub-type="epub">1536-5964</issn><publisher><publisher-name>Wolters Kluwer Health</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">31764808</article-id><article-id pub-id-type="pmc">6882656</article-id><article-id pub-id-type="publisher-id">MD-D-18-08404</article-id><article-id pub-id-type="doi">10.1097/MD.0000000000017982</article-id><article-id pub-id-type="art-access-id">17982</article-id><article-categories><subj-group subj-group-type="heading"><subject>5300</subject></subj-group><subj-group><subject>Research Article</subject><subject>Clinical Case Report</subject></subj-group></article-categories><title-group><article-title>Mild encephalitis/encephalopathy with a reversible splenial lesion secondary to encephalitis complicated by hyponatremia</article-title><subtitle>A case report and literature review</subtitle></title-group><contrib-group><contrib contrib-type="author"><name><surname>Shi</surname><given-names>Bi-chuan</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Li</surname><given-names>Jiao</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Jiang</surname><given-names>Ji-wei</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Li</surname><given-names>Mei-xin</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Zhang</surname><given-names>Jian</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Shang</surname><given-names>Xiu-li</given-names></name><degrees>MD</degrees><xref rid="cor1" ref-type="corresp"><sup>∗</sup></xref></contrib></contrib-group><contrib-group><contrib contrib-type="editor"><name><surname>NA.</surname><given-names></given-names></name></contrib></contrib-group><aff>Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China.</aff><author-notes id="cor1"><corresp><label>∗</label>Correspondence: Xiu-li Shang, Department of Neurology, The First Affiliated Hospital of China Medical University, 92 North Second Rd, Shenyang 110000, Liaoning Province, China (e-mail: <email>shang_zhao@sohu.com</email>).</corresp></author-notes><pub-date pub-type="collection"><month>11</month><year>2019</year></pub-date><pub-date pub-type="epub"><day>22</day><month>11</month><year>2019</year></pub-date><volume>98</volume><issue>47</issue><elocation-id>e17982</elocation-id><history><date date-type="received"><day>21</day><month>12</month><year>2018</year></date><date date-type="rev-recd"><day>6</day><month>10</month><year>2019</year></date><date date-type="accepted"><day>17</day><month>10</month><year>2019</year></date></history><permissions><copyright-statement>Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc.</copyright-statement><copyright-year>2019</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0"><license-p>This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0">http://creativecommons.org/licenses/by/4.0</ext-link></license-p></license></permissions><self-uri xlink:type="simple" xlink:href="medi-98-e17982.pdf"></self-uri><abstract><title>Abstract</title><sec><title>Rationale:</title><p>Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is an infection-associated encephalitis/encephalopathy syndrome that is predominately caused by a virus. MERS has no direct association with central nervous system (CNS) infections or inflammation. Non-CNS infections may cause reversible lesion in the splenium of corpus callosum. Recently, there have been reports of many patients with hyponatremia related MERS. Interleukin-6 (IL-6) was also found elevated in serum and in cerebrospinal fluid (CSF) in patients with MERS. The role of IL-6 in the non-osmotic release of vasopressin is crucial. Persistent hyponatremia may be linked to this effect. The following is a case report of MERS secondary to encephalitis, complicated by hyponatremia. We will summarize the latest research and progress regarding MERS.</p></sec><sec><title>Patient concerns:</title><p>A 31-year-old man was admitted to our department with a 5-day history of fever and headache. His initial diagnosis was encephalitis and hyponatremia; during this period the patient also developed MERS secondary to the encephalitis.</p></sec><sec><title>Diagnoses:</title><p>Encephalitis was diagnosed by reviewing the history of fever, headache, neck rigidity and Kerning sign (+) on clinical examination. Lab tests revealed: serum VCA IgG (+), EBNA-1 IgG (−), EBV IgM (−), and inflammation in the analysis of CSF. Cranial MRI+C showed that the blood vessels on the surface of the brain were obviously increasing and thickening and diffuse slow waves were detected on the electroencephalogram (EEG). The patient's hyponatremia aggravated on the third day of hospitalization. On the fourth day of hospitalization, the patient was somnolent, apathetic, and slow. Magnetic resonance imaging (MRI) of the brain, with a T2-weighted fluid attenuated inversion recovery image, showed high-signal intensity in the splenium of the corpus callosum (SCC) on the fifth day of hospitalization. Diffusion-weighted imaging (DWI) showed splenial hyperintensity as a “boomerang sign” and reduced diffusion on apparent diffusion coefficient (ADC) maps. Cranial MRI findings returned to normal after 1 month. The diagnosis of MERS was confirmed.</p></sec><sec><title>Interventions:</title><p>We administered an intravenous drip infusion of acyclovir and prescribed oral sodium supplementation.</p></sec><sec><title>Outcomes:</title><p>The patient's neurological symptoms gradually improved. The MRI lesion in the SCC disappeared on the 30th day.</p></sec><sec><title>Lessons:</title><p>In patients with encephalitis accompanied by hyponatremia, elevated IL-6 or urinary β2-microglobulin (β2MG), and exacerbations such as sudden somnolence, delirium, confusion, and seizures, the possibility of secondary MERS should be investigated, in addition to the progression of encephalitis.</p></sec></abstract><kwd-group><title>Keywords</title><kwd>encephalitis</kwd><kwd>hyponatremia</kwd><kwd>interleukin-6</kwd><kwd>mild encephalitis/encephalopathy with a reversible splenial lesion</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>OPEN-ACCESS</meta-name><meta-value>TRUE</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Curation/RBID.i -Sk "pubmed:31764808" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Curation/biblio.hfd \
| NlmPubMed2Wicri -a MersV1
| This area was generated with Dilib version V0.6.33. |  |