A case of MERS presenting with acute motor aphasia and tetraparesis and literature review

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dc.authoridSahan, Halime/0000-0003-4329-7011
dc.authoridyabalak, ahmet/0000-0002-3317-9567
dc.contributor.authorSahan, Halime
dc.contributor.authorYabalak, Ahmet
dc.date.accessioned2025-10-11T20:48:01Z
dc.date.available2025-10-11T20:48:01Z
dc.date.issued2024
dc.departmentDüzce Üniversitesien_US
dc.description.abstractBackgroundMild encephalopathy w & imath;th reversible splenial lesions (MERS) are a clinical-radiological diagnosis that can be diagnosed with radiological imaging and can be accompanied by impaired consciousness, aphasia, headache, and paralysis. MERS can be divided into two different types based on radiological findings; Involvement of the splenium is seen in type 1, and involvement of the splenium and deep white matter is seen in type 2. MERS Type 2 is very rare in adults. Here, we describe a patient diagnosed with MERS Type 2 and our therapeutic intervention.Case presentationA 22-year-old woman presented with slurred speech, weakness in the extremities and headache that started 14 h ago. The patient had sore throat and fever of 37.6 degrees C for 2 days, and medical history or family history were unremarkable. Neurological examination revealed that she was conscious, cooperative, with no signs of meningeal irritation. Speech comprehension, naming, and repetition were preserved, motor examination revealed 5/5 left upper extremity strength, 4/5 right upper extremity strength, and 2/5 bilateral lower extremity strength. Diffusion-weighted magnetic resonance imaging (MRI-DWI) revealed bilateral deep white matter and splenium symmetrical diffusion restriction. Blood tests showed high C-reactive protein (CRP) and no leukocytosis. No cells were detected in the cerebrospinal fluid (CSF), protein was 151 mg/dl, glucose was within normal limits. The patient, who developed quadriparesis during follow-up, was started on pulse dose steroids. Neurological examination improved to patient's baseline at the 12th hour of treatment. In the 72nd hour control MRI-DWI, it was seen that the lesions had regressed. Culture/Polymerase chain reaction (PCR) for bacterial/viral infection agents came back negative. After steroids were given for 5 days, patient was discharged at her baseline.ConclusionsMERS is a rare diagnosis in adults and can be radiologically confused with acute toxic leukoencephalopathy. It can be distinguished clinically by the absence of prior infection, fever, and toxic agent exposure. Although there is no consensus in the literature regarding the treatment, the clinical picture improved rapidly after steroid in our case. Despite being rare, it should be considered in the differential diagnosis of patients with deep white matter lesions in adults.en_US
dc.identifier.doi10.1186/s41983-024-00872-2
dc.identifier.issn1687-8329
dc.identifier.issue1en_US
dc.identifier.scopus2-s2.0-85201433345en_US
dc.identifier.scopusqualityN/Aen_US
dc.identifier.urihttps://doi.org/10.1186/s41983-024-00872-2
dc.identifier.urihttps://hdl.handle.net/20.500.12684/21716
dc.identifier.volume60en_US
dc.identifier.wosWOS:001293640800001en_US
dc.identifier.wosqualityN/Aen_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.language.isoenen_US
dc.publisherSpringeren_US
dc.relation.ispartofEgyptian Journal of Neurology Psychiatryand Neurosurgeryen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.snmzKA_WOS_20250911
dc.subjectSplenial lesionen_US
dc.subjectMERSen_US
dc.subjectLeukoencephalopathyen_US
dc.titleA case of MERS presenting with acute motor aphasia and tetraparesis and literature reviewen_US
dc.typeArticleen_US

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