Adult-Onset Reversible Splenial Lesion Syndrome: A Case Series and Review of Age-Related Differences

Abstract

Reversible splenial lesion syndrome (RESLES) is a neuroradiological entity described by a reversible lesion in the splenium of the corpus callosum (SCC) of unknown etiology. RESLES is often associated with infectious and metabolic diseases, seizure, and antiepileptic drugs withdrawal. Although clinical presentations are nonspecific, the syndrome is typically identified by its radiological aspects through magnetic resonance imaging (MRI). In this report, we present five cases of adult-onset RESLES (two males and three females) that were admitted in our department at a university hospital in the years between 2021 and 2025, with each case occurring in different clinical settings. We analyze their presentation, clinical course, and outcomes, and compare them with pediatric-onset cases to highlight potential age-related differences. Patients’ ages varied from 29 to 46 years old. Neurological symptoms included: headache 3/5, drowsiness 2/5, slurred speech 2/5, hearing loss 1/5, blurred vision 1/5, dysarthria 1/5, limb ataxia 1/5, postural tremors 1/5, insomnia 1/5, and agitation 1/5. One patient presented with a unique seizure then remained asymptomatic. The clinical settings associated with RESLES included the postpartum, infection, multiple organ failure, extensive cerebral venous thrombosis, and Burkitt lymphoma. Clinical outcomes at follow-up were favorable across all cases. In contrast to pediatric-onset RESLES, where symptoms and precipitating factors appear relatively homogeneous across studies with seizures as the predominant manifestation and infection as the leading cause, adult-onset cases demonstrate greater clinical and etiological heterogeneity. Analysis of our sample suggests that adult-onset RESLES shares the core radiological characteristics of the pediatric form but differs markedly in its common precipitating factors and clinical presentations.