Reversible Splenial Lesion Syndrome (RESLES)

Etiology

Infection

Metabolic Disorders

Other

  • Anti-Epileptic Drug Withdrawal
    • Pregabalin (Lyrica) (see Pregabalin, [[Pregabalin]]) Withdrawal
  • Cytokine Release Syndrome (see Cytokine Release Syndrome, [[Cytokine Release Syndrome]])
  • High-Altitude Cerebral Edema (HACE) (see

Physiology

  • Transient Lesions Involving the Splenium of the Corpus Callosum

Diagnosis

Brain MRI

  • Round-Shaped Lesion Centered in the Splenium of the Corpus Callosum: disappears after a variable lapse
    • Diffusion studies reveal DW hypersignal with low ADC values (consistent with cytotoxic edema)
    • Only high altitude cerebral edema-related cases and one patient with pregabalin withdrawal showed high ADC values (consistent with vasogenic edema)

Clinical Manifestations

Neurologic Manifestations

  • Non-Specific: absence of neurologic evidence of callosal disconnection

Treatment

  • Correction of Underlying Disorder/Supportive Care: most cases have a complete resolution after a variable lapse

References

  • Reversible splenial lesion syndrome (RESLES): what’s in a name? J Neuroimaging. 2011 Apr;21(2):e1-14. doi: 10.1111/j.1552-6569.2008.00279.x [MEDLINE]