CYTOTOXIC LESIONS OF THE CORPUS CALLOSUM: MAGNETIC RESONANCE IMAGING FINDINGS AND ETIOLOGIC FACTORS

Abstract

Objective: Cytotoxic lesions of the corpus callosum (CLOCCs) are usually detected as a diffusion restriction in the splenium of the corpus callosum. They are rare secondary radiological findings associated with various clinical entities. The aim of this study is to evaluate the magnetic resonance imaging (MRI) findings and underlying clinical factors of cases with CLOCCs. Materials and Methods: The MRI images of 850 patients who were admitted to the emergency services between January 2017 and March 2021 with encephalopathy and epilepsy-like neurological complaints were scanned retrospectively. Twenty nine patients (20 men, 9 women) with CLOCCs were included in the study. Their radiological and clinical findings were evaluated. Results: The mean age was calculated as 26.4 years (5-72 years). The patients had neurological symptoms such as dysarthria, confusion, ataxia, syncope, epileptic seizure, and headache. Lesions were developed secondary to various infections in 20 (68.9%) patients. Diabetic decompensation was found in three patients and uremic decompensation in one patient. In the remaining patients, subarachnoid hemorrhage, asthma attack, trauma, high-dose lithium-levetiracetam intake and anti-epileptic drug withdrawal were responsible. Twenty patients had MRI control. In 16 (80%) patients, MRI findings returned to normal between 6 days and 8 months (median 30, Mean 53.8 days). One of the other 4 patients had partial regression, and 3 patients recovered with sequelae gliosis. Conclusion: CLOCCs are nonspecific MRI findings associated with a broad underlying clinical spectrum. They are usually reversible. Determination of the underlying clinical etiology, avoidance of an ischemic stroke and tumor-like misdiagnoses are important for appropriate patient management.

Keywords

• Cytotoxic callosal lesions
• reversible splenial lesion
• splenium
• corpus callosum

KORPUS KALLOZUMUN SİTOTOKSİK LEZYONLARI: MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI VE ETİYOLOJİK FAKTÖRLER

Abstract

Amaç: Korpus kallozumun sitotoksik lezyonları (KKSL) genellikle korpus kallozum spleniumunda diffüzyon kısıtlılığı olarak saptanan farklı birçok klinik durum ile ilişkilendirilmiş nadir bir radyolojik bulgudur. Çalışmamızın amacı kliniğimizde manyetik rezonans görüntülemesinde (MRG) KKSL saptanan olguların radyolojik ve klinik bulgularını incelemek ve literatür eşliğinde değerlendirmektir. Gereç ve Yöntem: Ocak 2017 – Mart 2021 tarihleri arasında erişkin ve pediatri acil servislerine ensefalopati ve epilepsi benzeri nörolojik şikayetler ile başvuran, diffüzyon veya kraniyal MRG çekilmiş yaklaşık 850 hastanın görüntülemeleri retrospektif olarak tarandı. KKSL saptanan 29 hasta (20 erkek, 9 kadın) çalışmaya dahil edilerek radyolojik ve klinik bulguları değerlendirildi. Bulgular: Yaş ortalaması 26,4 yıl (5-72 yıl) olarak hesaplandı. Hastalarda dizartri, bilinç bulanıklığı, ataksi, senkop, epileptik nöbet, baş ağrısı gibi nörolojik semptomlar mevcuttu. Hastalardan 20 (%68,9) tanesinde çeşitli enfeksiyonların merkezi sinir sisteminine direkt veya indirekt etkisi ile lezyonların geliştiği görüldü. Üç hastada diyabetik, bir hastada üremiye bağlı metabolik dekompansasyon saptanmıştır. Diğer 5 hastada; subaraknoid hemoraji, astım atağı, travma, yüksek doz lityum - levetirasetam alımı ve antiepileptik ilaç çekilmesi gibi etyolojik faktörlere bağlı geliştiği değerlendirildi. Yirmi hastada MR kontrolü bulunmaktaydı. 16 (%80) hastada bulgular 6 gün ile 8 ay arasında normale dönmüştür (Median 30, Ortalama 53,8 gün). Diğer 4 hastadan birinde parsiyel regresyon olduğu, 3 hastada sekel gliozis ile iyileştiği izlendi. Sonuç: Kallozal sitotoksik lezyonlar altta yatan geniş bir klinik spektrum ile ilişkili nonspesifik kranial MRG bulgularıdır. Genellikle geri dönüşümlüdür. Radyolojik olarak tanınmaları, altta yatan klinik etiyolojinin saptanması, iskemik inme ve tümör benzeri yanlış tanılardan kaçınılması, uygun hasta yönetimi için önemlidir. 

Keywords

• Sitotoksik kallozal lezyonlar
• reversibl splenial lezyon
• korpus kallozum

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