Clinical and Radiological Significance of Transient Brain Lesion in the Corpus Callosum Splenium: 2 Case Reports
Abstract
Although rare, splenium of the corpus callosum (SCC) may be involved in many etiological conditions. Most forms of involvement
are permanent and minorities of these are transient. The pathophysiology is intra-myelinic axonal edema related to hyponatremia
and local inflammatory cell infiltration. The first case; 34-years-old
female patient accepted to our unit with recurrent complex-partial
seizures. She had epilepsy for 10 years and carbamazepine using
for 4 years. Second case; 22-years-old female patient presented
with vomiting, nausea and visual deficiency. Both cases magnetic
resonance imaging (MRI) showed focal diffusion limitation in SCC.
A comprehensive diagnostic work-up was carried out to account
for these clinical and neuro-radiological presentations. 1-month
follow up MRI showed resolution of these lesions. Previously, transient limitation of diffusion of SCC has been mostly reported in epileptic patients and treatment with anti-epileptic agents. However,
many other conditions may result the appearance of similar clinical states. These patients may have mild form of encephalopathy
and the prognosis is generally good. MRI is particularly sensitive in
early identification of these lesions. A good understanding of the
transient nature of the condition may allow avoidance from unnecessary invasive diagnostic and therapeutic methods.
References
- 1. Bourekas EC, Varakis K, Bruns D, Christoforidis GA, Baujan M, Slone HW, et al. Lesions of the corpus callosum: MR imaging and differential considerations in adults and children. American Journal of Roentgenology 2002;179(1):251–57. 2. Marsala SZ, Antichi E, Pistacchi M, Gioulis M, Candeago RM, Montemurro RT, et al. Mild encephalitis with a reversible splenial lesion: A clinical benign condition, often underrecognized-Clinical case and literature review. Journal of neurosciences in rural practice 2017;8(2):281. 3. Maeda M, Shiroyama T, Tsukahara H, Shimono T, Aoki S, Takeda K. Transient splenial lesion of the corpus callosum associated with antiepileptic drugs: evaluation by diffusionweighted MR imaging. Eur Radiol 2003;13:1902–6. 4. Fukuda S, Kishi K, Yasuda K, Sejima H, Yamaguchi S. Rotavirusassociated encephalopathy with a reversible splenial lesion. Pediatr Neurol 2009;40:131–3. 5. Tada H, Takanashi J, Barkovich AJ, Oba H, Maeda M, Tsukahara H, et al. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion. Neurology 2004;63:1854–8. 6. Wilson CA, Mullen MT, Jackson BP, Ishida K, Messé SR. Etiology of corpus callosum lesions with restricted diffusion. Clinical neuroradiology 2017;27(1):31–7. 7. Kakou M, Velut S, Destrieux C. Arterial and venous vascularization of the corpus callosum. Neurochirurgie 1998;44:31–7. 8. Starkey J, Kobayashi N, Numaguchi Y, Moritani T. Cytotoxic lesions of the corpus callosum that show restricted diffusion: Mechanisms, causes, and manifestations. Radiographics 2017;37(2):562–76. 9. Krause KH, Rascher W, Berlit P. Plazma arginine vasopressin concentrations in epileptics under monotherapy. J Neurol 1983;230:193–6. 10. Al-Hashim AH, Blaser S, Raybaud C, MacGregor D. Corpus callosum abnormalities: neuroradiological and clinical correlations. Developmental Medicine & Child Neurology 2016;58(5):475–84.
Abstract
Korpus kallozumun spleniumu (KKS), birçok etiyolojik neden ile
nadir de olsa etkilenebilmektedir. Bu tutulumun bir kısmı kalıcı ve
az bir kısmı da geçicidir. Patofizyolojisinde hiponatremi ile ilişkili
intramiyelinik aksonal ödem ve lokal inflamatuar hücrelerin infilitrasyonu vardır. Birinci olgu; 34 yaşında kadın hasta, tekrarlayan
kompleks parsiyel nöbetler ile başvurdu. Özgeçmişinde, 10 yıldır
epilepsi hastalığı ve 4 yıldır karbamazepin kullanımı vardı. İkinci
olgu; 22 yaşında kadın hasta bulantı kusma ve görme bozukluğu şikayetleri ile başvurdu. Kranial manyetik rezonans görüntüleme
(MRG)’lerinde KKS’de fokal difüzyon kısıtlamaları izlendi. Bu klinik
ve nöroradyolojik görünüme sebep olabilecek diğer tüm faktörler
araştırıldı. Bir ay sonraki kranial MRG incelemelerinde bu lezyonların düzelmiş olduğu görüldü. KKS’nda geçici difüzyon kısıtlamaları
daha çok epilepsi hastalarında ve antiepileptik ilaç kullanımlarında
bildirilmiştir. Fakat birçok durum benzer görüntüye sebep olabilmektedir. Bu olgularda hafif bir ensefalopati görülebilir ve prognoz
genellikle iyidir. MRG bu lezyonların erken dönemde saptanmasında oldukça duyarlıdır. Bu klinik durumun geçici olduğunu bilmek,
girişimsel tanı ve tedavi yöntemlerinden kaçınmamızı sağlayabilir.
References
- 1. Bourekas EC, Varakis K, Bruns D, Christoforidis GA, Baujan M, Slone HW, et al. Lesions of the corpus callosum: MR imaging and differential considerations in adults and children. American Journal of Roentgenology 2002;179(1):251–57. 2. Marsala SZ, Antichi E, Pistacchi M, Gioulis M, Candeago RM, Montemurro RT, et al. Mild encephalitis with a reversible splenial lesion: A clinical benign condition, often underrecognized-Clinical case and literature review. Journal of neurosciences in rural practice 2017;8(2):281. 3. Maeda M, Shiroyama T, Tsukahara H, Shimono T, Aoki S, Takeda K. Transient splenial lesion of the corpus callosum associated with antiepileptic drugs: evaluation by diffusionweighted MR imaging. Eur Radiol 2003;13:1902–6. 4. Fukuda S, Kishi K, Yasuda K, Sejima H, Yamaguchi S. Rotavirusassociated encephalopathy with a reversible splenial lesion. Pediatr Neurol 2009;40:131–3. 5. Tada H, Takanashi J, Barkovich AJ, Oba H, Maeda M, Tsukahara H, et al. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion. Neurology 2004;63:1854–8. 6. Wilson CA, Mullen MT, Jackson BP, Ishida K, Messé SR. Etiology of corpus callosum lesions with restricted diffusion. Clinical neuroradiology 2017;27(1):31–7. 7. Kakou M, Velut S, Destrieux C. Arterial and venous vascularization of the corpus callosum. Neurochirurgie 1998;44:31–7. 8. Starkey J, Kobayashi N, Numaguchi Y, Moritani T. Cytotoxic lesions of the corpus callosum that show restricted diffusion: Mechanisms, causes, and manifestations. Radiographics 2017;37(2):562–76. 9. Krause KH, Rascher W, Berlit P. Plazma arginine vasopressin concentrations in epileptics under monotherapy. J Neurol 1983;230:193–6. 10. Al-Hashim AH, Blaser S, Raybaud C, MacGregor D. Corpus callosum abnormalities: neuroradiological and clinical correlations. Developmental Medicine & Child Neurology 2016;58(5):475–84.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Case Report |
| Authors | |
| Publication Date | August 1, 2018 |
| Published in Issue | Year 2018 |