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Table of Contents    
NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 4  |  Page : 1112-1113

A Wide Range of High Signal Intensities on Brain Image in Adult Mycoplasma Pneumoniae-Associated Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion


1 Department of Neurology, The Chinese People's Liberation Army General Hospital, Beijing, China
2 Department of Neurology, The Chinese People's Liberation Army General Hospital; Department of National Clinical Research Center of Geriatrics Disease, the Chinese People's Liberation Army General Hospital, Beijing, China

Date of Submission03-Sep-2018
Date of Decision19-Jun-2019
Date of Acceptance20-Mar-2020
Date of Web Publication2-Sep-2021

Correspondence Address:
Qiang Shi
Department of Neurology and National Clinical Research Center of Geriatrics Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing - 100853
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.325373

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How to cite this article:
Zhang Y, Shi Q. A Wide Range of High Signal Intensities on Brain Image in Adult Mycoplasma Pneumoniae-Associated Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion. Neurol India 2021;69:1112-3

How to cite this URL:
Zhang Y, Shi Q. A Wide Range of High Signal Intensities on Brain Image in Adult Mycoplasma Pneumoniae-Associated Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion. Neurol India [serial online] 2021 [cited 2021 Sep 27];69:1112-3. Available from: https://www.neurologyindia.com/text.asp?2021/69/4/1112/325373




A 24-year-old man previously healthy was presented with fever and headache for four days, coupled with restlessness and slurred speech for 1 day. Diffusion-weighted image (DWI) showed a wide range of markedly hyperintense lesions in the white matter around the bilateral lateral ventricle and body of corpus callosum [Figure 1]a. The genu and splenium of corpus callosum were simultaneously affected [Figure 1]b. The antibody tests of mycoplasma pneumoniae were positive, while other tests of antiviral antibodies were all negative. The patient was then treated by injectable azithromycin, 0.5 g per day for 7 days. Following, the clinical symptoms of the patient were relieved and his brain MRI resembled a virtually normal image [Figure 2]a and [Figure 2]b. The diagnosis was mycoplasma pneumoniae-associated mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) type II, which is considered rare for an adult – especially with such a large area of lesion location.
Figure 1: DWI findings on the day of admission. (a) A wide range of high signal intensities on DWI in the white matter around the bilateral lateral ventricle and body of corpus callosum. (b) The genu and splenium of corpus callosum were simultaneously affected

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Figure 2: DWI findings on the 7th day after using azithromycin. (a and b) Compared with Figure 1, the signal intensity on DWI was much lower and more closely resembled a normal brain image

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MERS has an unclear pathophysiological mechanism and various manifestations. Pneumoniae is one of the causative agents identified in MERS patients.[1] According to the findings on brain imaging, MERS is classified into two types. Type I involved solitary hyperintensity lesions in the splenium of the corpus callosum and type II also involved other brain areas.[2]Azithromycin is useful for the mycoplasma pneumoniae-associated MERS, and the prognosis of this disease is good. The critical point is to recognize it and make the treatment as soon as possible.

Financial support and sponsorship

This work was supported by the National Natural Science Foundation of China (No. 81771358).

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ueda N, Minami S, Akimoto M. Mycoplasma pneumoniae -associated mild encephalitis/encephalopathy with a reversible splenial lesion: Report of two pediatric cases and a comprehensive literature review. BMC Infect Dis2016;16:671.  Back to cited text no. 1
    
2.
Notebaert A, Willems J, Coucke L, Van Coster R, Verhelst H. Expanding the spectrum of MERS type 2 lesions, a particular form of encephalitis. Pediatr Neurol 2013;48:135-8.  Back to cited text no. 2
    


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