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Resumen El síndrome de lesión esplénica reversible (RESLES) corresponde a una lesión transitoria presente en un espectro de entidades con características clínicas y radiológicas definidas con buen pronóstico. La lesión esplénica reversible con encefalopatía/encefalitis leve (MERS) hace parte de este grupo de enfermedades. Presentamos el caso de una niña con un cuadro clínico que inicia con un pródromo febril y evoluciona hacia alteración de estado de conciencia. Se realiza resonancia magnética (RMN) cerebral simple que muestra lesión en el esplenio del cuerpo calloso hipointensa en T1 e hiperintensa en T2 y FLAIR, con restricción en la difusión y mapa de ADC. La sintomatología y los hallazgos radiológicos se resolvieron a partir de las 4 semanas. El cuadro clínico y el curso imagenológico de este caso corresponde a un cuadro típico de MERS. Esta entidad tiene baja incidencia y es poco conocida en nuestro país, razones por las cuales el diagnóstico es difícil en la mayoría de los casos.

Summary The Reversible Splenial Lesions Syndrome (RESLES) has been described as a transient lesion in a group of diseases with special clinical and radiological features and with a good prognosis. An encephalopathy with a reversible splenium of the corpus callosum lesion (MERS) is part of these diseases. We present a case report of an 11 years old female with a febrile prodromal phase that evolved into an altered state of consciousness. Simple brain MRI findings comprise a lesion in the splenium of the corpus callosum, hypointense on T1, hyperintense on T2 and FLAIR, with restricted diffusion on ADC. The clinical symptoms and radiological findings resolved after 4 weeks. The clinical course and images of this case are typical presentation of MERS. This entity has a low incidence and not very renowned in our country, for this reason, the diagnosis is difficult in most cases.

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Se presenta el caso clínico de una infante de 13 meses de edad, con antecedente de agenesia del cuerpo calloso, quien ingresó en la sala de nutrición del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba por presentar ganancia insuficiente peso, pérdida de la visión en ambos ojos y audición disminuida. Se realizó resonancia magnética por imágenes donde la presencia del esplenio confirmó la agenesia parcial.

The case report of a 13 months child is presented with a history of agenesis of the corpus callosum, who was admitted in the nutrition room of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, due to poor weight gain, loss of vision in both eyes and diminished audition. A magnetic resonance imaging was carried out where the presence of the splenium confirmed the partial agenesis.

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Axons and glial cells are the main components of white matter. The corpus callosum (CC) is the largest white matter tract in mammals; in rodents, 99% of the cells correspond to glia after postnatal day 5 (P5). The area of the CC varies through life and regional differences related to the number of axons have been previously described. Whether glial cell density varies accordingly is unknown; thus the aim of this study was to estimate glial cell density for the genu, body and splenium -the three main regions of CC-, of P6 and P30 rats. Here we report that the density of CC glial cells reduced by ~10% from P6 to P30. Even so, the density of astrocytes showed a slight increase (+6%), probably due to differentiation of glioblasts. Interestingly, glial cell density decreased for the genu (-21%) and the body (-13%), while for the splenium a minor increase (+5%) was observed. The astrocyte/glia ratio increased (from P6 to P30) for the genu (+27%), body (+17%) and splenium (+4%). Together, our results showed regional differences in glial cell density of the CC. Whether this pattern is modified in some neuropathologies remains to be explored.

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The effect of prenatal malnutrition on the anatomy of the corpus callosum was assessed in adult rats (45-52 days old). In the prenatally malnourished animals we observed a significant reduction of the corpus callosum total area, partial areas, and perimeter, as compared with normal animals. In addition, the splenium of corpus callosum (posterior fifth) showed a significant decrease of fiber diameters in the myelinated fibers without changing density. There was also a significant decrease in diameter and a significant increase in density of unmyelinated fibers. Measurements of perimeter's fractal dimensions from sagittal sections of the brain and corpus callosum did not show significant differences between malnourished and control animals. These findings indicate that cortico-cortical connections are vulnerable to the prenatal malnutrition, and suggest this may affect interhemispheric conduction velocity, particulary in visual connections (splenium).

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Ratas malnutridas prenatalmente con una dieta isocalórica y baja en proteínas, presentaron un menor diámetro axonal promedio en el esplenio callosal que los animales control, tanto de las fibras mielínicas como amielínicas. También se observó una mayor densidad axonal promedio, con respecto a los controles. Estas observaciones sugieren que: 1) las conexiones cortico-corticales (interhemisféricas) son vulnerables a la malnutrición proteica; y 2) lo anterior tendría incidencia en la velocidad de conducción interhemisférica, en particular con lo que dice relación con las conexiones visuales.

Adult rats malnourished prenatally with a low-protein, isocaloric diet showed smaller median fiber diameter of myelinated and unmyelinated fibers and a higher axonal density in the callosal splenium than controls. These findings suggest (i) that cortico-cortical (interhemispheric) connections are vulnerable to protein malnutrition; and (ii) this may affect interhemispheric conduction velocity, particularly in visual connections.

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