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Straeten FA, Meyer zu Hörste G. Cytotoxic corpus callosum lesion and mild CSF pleocytosis during hantavirus infection: a case report. Ther Adv Neurol Disord 2022; 15:17562864221144808. [PMID: 36601083 PMCID: PMC9806393 DOI: 10.1177/17562864221144808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/25/2022] [Indexed: 12/28/2022] Open
Abstract
A middle-aged, previously healthy male patient presented with high fever, headache, and aching limbs for 3 days. Laboratory results showed signs of acute kidney injury, elevated procalcitonin, and mild thrombocytopenia. On neurological examination, he had no focal neurological deficits, especially no meningism or visual disturbances. Cerebrospinal fluid (CSF) examination showed mild lymphocytic pleocytosis, and magnetic resonance imaging (MRI) revealed a lesion of the splenium corporis callosum. The patient received anti-infective treatment with acyclovir and ceftriaxone until laboratory results returned positive hantavirus IgM and IgG antibodies in the serum indicating an active hantavirus infection. The renal retention parameters and thrombocytopenia receded following treatment with intravenous fluids, analgesic, and antipyretic agents. MRI follow-up 10 days later showed a residual small FLAIR-positive lesion without any persistent callosal diffusion abnormality. The patient was discharged symptom-free after 8 days and had recovered fully 2 months later. The source of infection in this patient remained unclear. Cytotoxic lesions of the corpus callosum (CLCC) are secondary lesions usually with a good prognosis but require further investigation regarding their underlying etiology and should not be confounded with primary callosal lesions, such as ischemia or lymphoma.
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Affiliation(s)
| | - Gerd Meyer zu Hörste
- Department of Neurology with Institute of
Translational Neurology, University Hospital Muenster, Muenster,
Germany
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2
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Singh R, Kaur R, Pokhariyal P, Aggarwal R. Sequential MR imaging (with diffusion-weighted imaging) changes in metronidazole-induced encephalopathy. Indian J Radiol Imaging 2021; 27:129-132. [PMID: 28744071 PMCID: PMC5510308 DOI: 10.4103/ijri.ijri_341_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Metronidazole-induced neuro-toxicity, though rare, is known. A characteristic spatial distribution of lesions in cerebellar dentate nuclei and dorsal pons is known. However, temporal progression of lesions on magnetic resonance imaging (MRI) has not been described previously. We describe two such cases which presented initially with splenial hyperintesity and showed progression to characterstic lesions. Both cases improved with stoppage of metronidazole.
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Affiliation(s)
- Rupinder Singh
- Department of Neuroradiology, Sri Bala Ji Action Medical Institute, New Delhi, India
| | - Ramanjeet Kaur
- Department of Gynaecology, Kasturba Hospital, New Delhi, India
| | - Pawan Pokhariyal
- Department of Neurology, Sri Bala Ji Action Medical Institute, New Delhi, India
| | - Rajul Aggarwal
- Department of Neurology, Sri Bala Ji Action Medical Institute, New Delhi, India
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3
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Maramattom BV, Rathish B, Meleth HA. Miller Fisher Syndrome and Boomerang Sign: A Rare Presentation of Typhoid Fever. Cureus 2021; 13:e15386. [PMID: 34249538 PMCID: PMC8253474 DOI: 10.7759/cureus.15386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 11/21/2022] Open
Abstract
Miller Fischer syndrome (MFS) is a variant of Guillain-Barré syndrome which is characterized by a triad of ataxia, ophthalmoplegia, and areflexia. It is uncommonly associated with systemic illnesses. We present the case of a young boy who came back after a trip to New Delhi in India, who developed MFS. MRI showed a callosal splenial hyperintensity which is called the boomerang sign. The evaluation revealed typhoid fever. This is probably the first such report of MFS associated with this infection.
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4
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Pagola-Lorz I, Cámara M, Diaz-Pertuz E, Erro M. Coma por lesión reversible del cuerpo calloso. Neurologia 2020; 35:671-672. [DOI: 10.1016/j.nrl.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 10/19/2019] [Indexed: 10/25/2022] Open
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5
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Pagola-Lorz I, Cámara M, Diaz-Pertuz E, Erro M. Coma secondary to a reversible lesion to the corpus callosum. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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6
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Lewis R, Ruiz A, Monteith T. Reversible Lesion of the Corpus Callosum in a Patient With Migraine With Aura: A Case Study. Headache 2020; 60:791-792. [DOI: 10.1111/head.13768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Armando Ruiz
- Radiology University of Miami Miller School of Medicine Miami FL USA
| | - Teshamae Monteith
- Neurology (Headache Division) University of Miami Miller School of Medicine Miami FL USA
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Cirnigliaro G, Di Bernardo I, Caricasole V, Piccoli E, Scaramelli B, Pomati S, Villa C, Pantoni L, Dell'Osso B. Treatment-related transient splenial lesion of the Corpus Callosum in patients with neuropsychiatric disorders: a literature overview with a case report. Expert Opin Drug Saf 2020; 19:315-325. [PMID: 32063066 DOI: 10.1080/14740338.2020.1731472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Transient-localized lesions of the splenium of the corpus callosum (SCC) have been described in various clinical conditions, some of them being attributed to the withdrawal of psychotropic drugs. The pathophysiology of the lesion reflects cytotoxic edema and reversible demyelination.Areas covered: The present article aimed at reviewing cases of transient SCC lesion exclusively related to changes in pharmacotherapy. It also reports the original case of a patient receiving a complex psychopharmacological therapy who developed a transient SCC lesion investigated by magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), and pharmacogenetic profiling.Expert opinion: To date, only one review on the subject has been published, analyzing 22 cases of transient SCC lesion arising in epileptic patients on antiepileptic therapy. It hypothesized that the nature of the lesion is a cytotoxic edema and the cases described in the subsequent 14 years seem to support this hypothesis. The authors reported the case of an Italian-Egyptian patient who developed a transient SCC lesion after the rapid withdrawal of Carbamazepine and Lurasidone. The lesion completely disappeared from the MRI performed after 1 month. Patient's ethnic group and its pharmacogenetic profile were considered as possible causes of altered drug metabolism and, likely, of the SCC lesion.
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Affiliation(s)
- Giovanna Cirnigliaro
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Ilaria Di Bernardo
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Valentina Caricasole
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Eleonora Piccoli
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Barbara Scaramelli
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Simone Pomati
- Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Neurology Unit, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Chiara Villa
- Department of Radiology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Leonardo Pantoni
- Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, Neurology Unit, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy.,Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche, University of Milan, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, CA, USA.,Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche, University of Milan, Milan, Italy.,"Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
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Blaauw J, Meiners LC. The splenium of the corpus callosum: embryology, anatomy, function and imaging with pathophysiological hypothesis. Neuroradiology 2020; 62:563-585. [PMID: 32062761 PMCID: PMC7186255 DOI: 10.1007/s00234-019-02357-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/27/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE The splenium of the corpus callosum is the most posterior part of the corpus callosum. Its embryological development, anatomy, vascularization, function, imaging of pathology, possible pathophysiological mechanisms by which pathology may develop and the clinical consequences are discussed. METHODS A literature-based description is provided on development, anatomy and function. MR and CT images are used to demonstrate pathology. The majority of pathology, known to affect the splenium, and the clinical effects are described in three subsections: (A) limited to the splenium, with elaboration on pathophysiology of reversible splenial lesions, (B) pathology in the cerebral white matter extending into or deriving from the splenium, with special emphasis on tumors, and (C) splenial involvement in generalized conditions affecting the entire brain, with a hypothesis for pathophysiological mechanisms for the different diseases. RESULTS The development of the splenium is preceded by the formation of the hippocampal commissure. It is bordered by the falx and the tentorium and is perfused by the anterior and posterior circulation. It contains different caliber axonal fibers and the most compact area of callosal glial cells. These findings may explain the affinity of specific forms of pathology for this region. The fibers interconnect the temporal and occipital regions of both hemispheres reciprocally and are important in language, visuospatial information transfer and behavior. Acquired pathology may lead to changes in consciousness. CONCLUSION The development, location, fiber composition and vascularization of the splenium make it vulnerable to specific pathological processes. It appears to play an important role in consciousness.
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Affiliation(s)
- J Blaauw
- Department of Radiology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands.,Faculty of Medical Sciences/Department of Neurology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands
| | - L C Meiners
- Department of Radiology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, The Netherlands.
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Jing C, Sun L, Wang Z, Chu C, Lin W. Reversible splenial lesion syndrome due to oxcarbazepine withdrawal: case report and literature review. J Int Med Res 2018; 46:1277-1281. [PMID: 29322880 PMCID: PMC5972250 DOI: 10.1177/0300060517736452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Reversible splenial lesion syndrome is a distinct entity radiologically characterized by a reversible lesion in the splenium of the corpus callosum. According to previous reports, this condition may be associated with antiepileptic drug use or withdrawal. We herein report a case of reversible splenial lesion syndrome associated with oxcarbazepine withdrawal. Case Report A 39-year-old man presented with an 8-year history of epileptic seizures. During the previous 3 years, he had taken oxcarbazepine irregularly. One week prior to admission, he withdrew the oxcarbazepine on his own, and the epilepsy became aggravated. Magnetic resonance imaging (MRI) revealed an isolated lesion in the splenium of the corpus callosum with slight hypointensity on T1-weighted imaging and slight hyperintensity on T2-weighted imaging. Regular oxcarbazepine was prescribed. Over a 5-month follow-up period, repeat MRI showed that the abnormal signals in the splenium of the corpus callosum had completely disappeared. Conclusion Reversible splenial lesion syndrome is a rare clinicoradiological disorder that can resolve spontaneously with a favorable outcome. Clinicians should be aware of this condition and that oxcarbazepine withdrawal is a possible etiological factor.
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Affiliation(s)
- Chaoyang Jing
- Department of Neurology, Neuroscience Center, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Lichao Sun
- Department of Emergency, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhuo Wang
- Department of Neurology, Neuroscience Center, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Chaojia Chu
- Department of Neurology, Neuroscience Center, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Weihong Lin
- Department of Neurology, Neuroscience Center, the First Hospital of Jilin University, Changchun, Jilin, China
- Weihong Lin, Department of Neurology, Neuroscience Center, the First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin 130021, China.
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10
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Park SE, Choi DS, Shin HS, Baek HJ, Choi HC, Kim JE, Choi HY, Park MJ. Splenial Lesions of the Corpus Callosum: Disease Spectrum and MRI Findings. Korean J Radiol 2017; 18:710-721. [PMID: 28670166 PMCID: PMC5447647 DOI: 10.3348/kjr.2017.18.4.710] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/18/2016] [Indexed: 11/17/2022] Open
Abstract
The corpus callosum (CC) is the largest white matter structure in the brain, consisting of more than 200–250 million axons that provide a large connection mainly between homologous cerebral cortical areas in mirror image sites. The posterior end of the CC is the thickest part, which is called the splenium. Various diseases including congenital to acquired lesions including congenital anomalies, traumatic lesions, ischemic diseases, tumors, metabolic, toxic, degenerative, and demyelinating diseases, can involve the splenium of the CC and their clinical symptoms and signs are also variable. Therefore, knowledge of the disease entities and the imaging findings of lesions involving the splenium is valuable in clinical practice. MR imaging is useful for the detection and differential diagnosis of splenial lesions of the CC. In this study, we classify the disease entities and describe imaging findings of lesions involving the splenium of the CC based on our experiences and a review of the literature.
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Affiliation(s)
- Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju 52727, Korea
| | - Dae Seob Choi
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju 52727, Korea.,Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju 52727, Korea
| | - Hwa Seon Shin
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju 52727, Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju 52727, Korea
| | - Ho Cheol Choi
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju 52727, Korea
| | - Ji Eun Kim
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju 52727, Korea
| | - Hye Young Choi
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju 52727, Korea
| | - Mi Jung Park
- Department of Radiology, Gyeongsang National University School of Medicine, Jinju 52727, Korea
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11
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Starkey J, Kobayashi N, Numaguchi Y, Moritani T. Cytotoxic Lesions of the Corpus Callosum That Show Restricted Diffusion: Mechanisms, Causes, and Manifestations. Radiographics 2017; 37:562-576. [PMID: 28165876 DOI: 10.1148/rg.2017160085] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cytotoxic lesions of the corpus callosum (CLOCCs) are secondary lesions associated with various entities. CLOCCs have been found in association with drug therapy, malignancy, infection, subarachnoid hemorrhage, metabolic disorders, trauma, and other entities. In all of these conditions, cell-cytokine interactions lead to markedly increased levels of cytokines and extracellular glutamate. Ultimately, this cascade can lead to dysfunction of the callosal neurons and microglia. Cytotoxic edema develops as water becomes trapped in these cells. On diffusion-weighted magnetic resonance (MR) images, CLOCCs manifest as areas of low diffusion. CLOCCs lack enhancement on contrast material-enhanced images, tend to be midline, and are relatively symmetric. The involvement of the corpus callosum typically shows one of three patterns: (a) a small round or oval lesion located in the center of the splenium, (b) a lesion centered in the splenium but extending through the callosal fibers laterally into the adjacent white matter, or (c) a lesion centered posteriorly but extending into the anterior corpus callosum. CLOCCs are frequently but not invariably reversible. Their pathologic mechanisms are discussed, the typical MR imaging findings are described, and typical cases of CLOCCs are presented. Although CLOCCs are nonspecific with regard to the underlying cause, additional imaging findings and the clinical findings can aid in making a specific diagnosis. Radiologists should be familiar with the imaging appearance of CLOCCs to avoid a misdiagnosis of ischemia. When CLOCCs are found, the underlying cause of the lesion should be sought and addressed. ©RSNA, 2017 An earlier incorrect version of this article appeared online. This article was corrected on February 13, 2017.
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Affiliation(s)
- Jay Starkey
- From the Department of Radiology, St Luke's International Hospital, 9-1 Akashicho, Chuo, Tokyo 104-8560, Japan (J.S., N.K., Y.N.); and the Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.M.)
| | - Nobuo Kobayashi
- From the Department of Radiology, St Luke's International Hospital, 9-1 Akashicho, Chuo, Tokyo 104-8560, Japan (J.S., N.K., Y.N.); and the Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.M.)
| | - Yuji Numaguchi
- From the Department of Radiology, St Luke's International Hospital, 9-1 Akashicho, Chuo, Tokyo 104-8560, Japan (J.S., N.K., Y.N.); and the Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.M.)
| | - Toshio Moritani
- From the Department of Radiology, St Luke's International Hospital, 9-1 Akashicho, Chuo, Tokyo 104-8560, Japan (J.S., N.K., Y.N.); and the Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa (T.M.)
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12
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Nagpal K, Agarwal P, Kumar A, Reddi R. Chikungunya infection presenting as mild encephalitis with a reversible lesion in the splenium: a case report. J Neurovirol 2017; 23:501-503. [PMID: 28105556 DOI: 10.1007/s13365-017-0515-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/23/2016] [Accepted: 01/10/2017] [Indexed: 12/14/2022]
Abstract
Chikungunya fever is an Aedes mosquito-transmitted infection caused by chikungunya virus, an RNA virus in the family Togaviridae. The disease is characteristically manifested as fever, arthralgia, and/or rash. Various neurological manifestations like meningoencephalitis, myelitis, and myeloneuropathy have been mentioned in various reports. We present a rare case of chikungunya fever presenting with mild encephalitis with a reversible lesion of the splenium (MERS), which showed complete clinical and radiological recovery.
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Affiliation(s)
- Kadam Nagpal
- Department of Neurology, Max Superspeciality Hospital, Saket, New Delhi, India.
| | - Puneet Agarwal
- Department of Neurology, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Amit Kumar
- Department of Radiodiagnosis, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Rajashekhar Reddi
- Department of Neurology, Max Superspeciality Hospital, Saket, New Delhi, India
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13
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Reversible Splenial Lesion Related to Acute Lithium Intoxication in a Bipolar Patient: A Case Report. J Clin Psychopharmacol 2016; 36:528-9. [PMID: 27482969 DOI: 10.1097/jcp.0000000000000544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Kim C, Choi HJ. Midline Splenial Lesion after Aneurysmal Subarachnoid Hemorrhage. JOURNAL OF NEUROCRITICAL CARE 2015. [DOI: 10.18700/jnc.2015.8.2.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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15
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Harini C, Das RR, Prabhu SP, Singh K, Haldar A, Takeoka M, Bergin AM, Loddenkemper T, Kothare SV. Clinical and Neuroimaging Profile of Children with Lesions in the Corpus Callosum. J Neuroimaging 2014; 25:824-31. [PMID: 25523474 DOI: 10.1111/jon.12190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 07/23/2014] [Accepted: 09/13/2014] [Indexed: 12/14/2022] Open
Abstract
PURPOSE T2-hyperintense signal changes in corpus callosum (CC) have been described in epilepsy and encephalitis/encephalopathy. Little is known about their pathophysiology. The aim of this study was to examine the clinical presentation and evolution of CC lesions and relationship to seizures. METHODS We identified 12 children among 29,634 patients from Radiology Database. We evaluated following characteristics: seizures and accompanying medical history, antiepileptic drug usage, presenting symptoms, and radiological evolution of lesions. RESULTS CC lesions were seen in patients with prior diagnosis of epilepsy (n = 5) or in those with new onset seizures (n = 3), or with encephalitis/encephalopathy without history of seizures (n = 4). Seizure clustering or disturbances of consciousness were the main presenting symptoms. No relationship was observed between CC lesion and AEDs. On imaging, ovoid lesions at presentation resolved on follow up imaging and linear lesions persisted. DTI showed that the fibers passing through splenial lesions originated from the posterior parietal cortex and occipital cortex bilaterally. CONCLUSION In patients with seizures, no clear relationship was demonstrated between seizure characteristics or AED use with CC lesions. Ovoid lesions resolved and may have different pathophysiologic mechanism when compared to linear lesions that persisted.
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Affiliation(s)
- Chellamani Harini
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Rohit R Das
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA.,Department of Neurology, Indiana State University, Indianapolis, IN
| | - Sanjay P Prabhu
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Harvard Medical School, Boston, MA
| | - Kanwaljit Singh
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA.,Lurie Center, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA
| | - Amit Haldar
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Masanori Takeoka
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Ann M Bergin
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Tobias Loddenkemper
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Sanjeev V Kothare
- Division of Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA.,New York University Medical Center, Comprehensive Epilepsy Center, Langone Medical School, NY
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16
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McAndrew S, Listernick R, Kuntz N. Cerebellar mutism in acute disseminating encephalomyelitis. Pediatr Neurol 2014; 50:511-4. [PMID: 24656209 DOI: 10.1016/j.pediatrneurol.2014.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/20/2013] [Accepted: 01/05/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cerebellar mutism in children occurs after posterior fossa tumor resection and can have lasting effects on cognition, language, and behavior. Cerebellar mutism in acute disseminated encephalomyelitis is rare. PATIENT A 7-year-old boy with a 3-day history of fever, vomiting, and diarrhea presented with altered mental status and expressive aphasia. Magnetic resonance imaging showed new diffusion restriction in the bilateral dentate nuclei and right cerebellum. With treatment, he began to verbalize again but had long-term cognitive and language difficulties. CONCLUSION Acute disseminated encephalomyelitis is commonly a benign process, but its effect on the cerebellum can be long-lasting.
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Affiliation(s)
- Sarah McAndrew
- Department of Pediatrics, Northwestern University, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | - Robert Listernick
- Academic General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nancy Kuntz
- Department of Pediatrics, Northwestern University, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
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17
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Moritani T, Capizzano A, Kirby P, Policeni B. Viral Infections and White Matter Lesions. Radiol Clin North Am 2014; 52:355-82. [DOI: 10.1016/j.rcl.2013.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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18
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Hillbom M, Saloheimo P, Fujioka S, Wszolek ZK, Juvela S, Leone MA. Diagnosis and management of Marchiafava-Bignami disease: a review of CT/MRI confirmed cases. J Neurol Neurosurg Psychiatry 2014; 85:168-73. [PMID: 23978380 PMCID: PMC4160728 DOI: 10.1136/jnnp-2013-305979] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Marchiafava-Bignami disease (MBD) is a rare condition mainly associated with alcoholism, although it may be mimicked by several other disorders that cause corpus callosum lesions. Our objective was to identify helpful features for differential diagnosis and assess whether any treatment can be recommended. METHODS We reviewed 122 reports containing data on 153 subjects with confirmed MBD that was associated with either alcoholism or malnutrition, and 20 reports with data on 53 subjects with conditions mimicking MBD. All the cases had been verified antemortem by brain imaging. Unconditional logistic regression was used to demonstrate factors that were associated with the outcome of MBD. RESULTS The mimicking conditions were differentiated from MBD by the occurrence of solitary and rapidly disappearing splenial lesions; fewer signs and symptoms with exception of seizures, hemiparesis and tetraparesis; nystagmus; and rapid and complete recovery. MBD occurred most frequently among alcoholics, but it was also reported in 11 non-alcoholics (7.2% of all the MBD cases). A better outcome was observed among those who were treated within 2 weeks after onset of symptoms with parenteral thiamine (p=0.033). CONCLUSIONS As thiamine deficiency is frequently associated with alcoholism, malnutrition and prolonged vomiting; we recommend prompt treatment of MBD with parenteral thiamine in such subjects. Recovery should be followed by repeated neuropsychological and MRI examinations, preferably using diffusion tensor imaging.
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Affiliation(s)
- Matti Hillbom
- Department of Neurology, Oulu University Hospital, , Oulu, Finland
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Yamashita C, Shigeto H, Maeda N, Kawaguchi M, Uryu M, Motomura S, Kira JI. Transient interhemispheric disconnection in a case of insulinoma-induced hypoglycemic encephalopathy. J Neurol Sci 2013; 335:233-7. [PMID: 24139556 DOI: 10.1016/j.jns.2013.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 09/10/2013] [Accepted: 09/17/2013] [Indexed: 11/19/2022]
Abstract
We report a case of a 22-year-old male who was transferred to our hospital in a comatose state following successive seizures. Low blood glucose had been detected upon his arrival at the previous hospital. He became responsive 12 days after the onset of coma. Upon regaining consciousness he exhibited severe dysarthria and several interhemispheric disconnection signs such as intermanual conflict, left-hand dysgraphia, left hemispatial neglect confined to the right hand, impaired interhemispheric transfer, and unilateral constructional apraxia of the right hand. Brain MRI disclosed T2-weighted and diffusion-weighted hyperintense lesions with reduced apparent diffusion coefficients in the bilateral centrum semiovale, splenium of the corpus callosum, right posterior limb of the internal capsule, and bilateral middle cerebellar peduncles. As the MRI findings vanished, his interhemispheric disconnection signs gradually resolved. Abdominal imaging studies revealed a pancreatic tumor, which was later endocrinologically diagnosed as an insulinoma. This is an extremely rare report of interhemispheric disconnection signs due to hypoglycemic encephalopathy. The lesions in the bilateral centrum semiovale likely contributed to the interhemispheric disconnection signs.
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Affiliation(s)
- Chikara Yamashita
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Japan
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Kazi AZ, Joshi PC, Kelkar AB, Mahajan MS, Ghawate AS. MRI evaluation of pathologies affecting the corpus callosum: A pictorial essay. Indian J Radiol Imaging 2013; 23:321-32. [PMID: 24604936 PMCID: PMC3932574 DOI: 10.4103/0971-3026.125604] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The corpus callosum is a midline cerebral structure and has a unique embryological development pattern. In this article, we describe the pathophysiology and present imaging findings of various typical/atypical conditions affecting the corpus callosum. Since many of these pathologies have characteristic appearances on magnetic resonance imaging (MRI) and their therapeutic approaches are poles apart, ranging from medical to surgical, the neuroradiologist should be well aware of them.
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Affiliation(s)
- Aamish Z Kazi
- Bharati Hospital and Research Centre, Pune, Maharashtra, India
| | | | | | | | - Amit S Ghawate
- Bharati Hospital and Research Centre, Pune, Maharashtra, India
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Malhotra HS, Garg RK, Vidhate MR, Sharma PK. Boomerang sign: Clinical significance of transient lesion in splenium of corpus callosum. Ann Indian Acad Neurol 2012; 15:151-7. [PMID: 22566735 PMCID: PMC3345598 DOI: 10.4103/0972-2327.95005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 04/29/2011] [Accepted: 06/01/2011] [Indexed: 12/14/2022] Open
Abstract
Transient signal abnormality in the splenium of corpus callosum on magnetic resonance imaging (MRI) is occasionally encountered in clinical practice. It has been reported in various clinical conditions apart from patients with epilepsy. We describe 4 patients with different etiologies presenting with signal changes in the splenium of corpus callosum. They were diagnosed as having progressive myoclonic epilepsy (case 1), localization-related epilepsy (case 2), hemicrania continua (case 3), and postinfectious parkinsonism (case 4). While three patients had complete involvement of the splenium on diffusion-weighted image (“boomerang sign”), the patient having hemicrania continua showed semilunar involvement (“mini-boomerang”) on T2-weighted and FLAIR image. All the cases had noncontiguous involvement of the splenium. We herein, discuss these cases with transient splenial involvement and stress that such patients do not need aggressive diagnostic and therapeutic interventions. An attempt has been made to review the literature regarding the pathophysiology, etiology, and outcome of such lesions.
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Affiliation(s)
- Hardeep Singh Malhotra
- Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Uttar Pradesh, Lucknow, India
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Takenouchi T, Heier LA, Engel M, Perlman JM. Restricted diffusion in the corpus callosum in hypoxic-ischemic encephalopathy. Pediatr Neurol 2010; 43:190-6. [PMID: 20691941 DOI: 10.1016/j.pediatrneurol.2010.04.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 03/31/2010] [Accepted: 04/26/2010] [Indexed: 11/28/2022]
Abstract
Restricted diffusion within the splenium of the corpus callosum was described in various conditions, but is not a prominent finding in magnetic resonance imaging after neonatal hypoxic-ischemic encephalopathy. Perinatal characteristics were reviewed in 42 term neonates with hypoxic-ischemic encephalopathy treated with selective head cooling. Neonatal images of 34 infants were reviewed. Ten of 34 (29%) infants demonstrated restricted diffusion changes within the splenium of the corpus callosum, with a significantly higher incidence of death or severe developmental delay, compared with infants without changes in the splenium of the corpus callosum (n = 24) (P = 0.002). The positive predictive value of changes in the splenium of the corpus callosum regarding poor outcomes or death was 90%. Changes in the splenium of the corpus callosum were also associated with lower birth weights, larger base deficits in cord arterial gas, and more severe encephalopathy during enrollment in selective head cooling. Restricted diffusion within the splenium of the corpus callosum of term infants with hypoxic-ischemic encephalopathy is often associated with extensive brain injury, and in these circumstances appears to be an early neuroradiologic marker of adverse neurologic outcomes.
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Affiliation(s)
- Toshiki Takenouchi
- Division of Pediatric Neurology, Department of Pediatrics, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10021, USA.
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Brain regional lesion burden and impaired mobility in the elderly. Neurobiol Aging 2009; 32:646-54. [PMID: 19428145 DOI: 10.1016/j.neurobiolaging.2009.04.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 04/02/2009] [Accepted: 04/12/2009] [Indexed: 11/20/2022]
Abstract
This study investigated the relationship of brain white matter (WM) lesions affecting specific neural networks with decreased mobility in ninety-nine healthy community-dwelling subjects ≥75 years old prospectively enrolled by age and mobility status. We assessed lesion burden in the genu, body and splenium of corpus callosum; anterior, superior and posterior corona radiata; anterior and posterior limbs of internal capsule; corticospinal tract; and superior longitudinal fasciculus. Burden in the splenium of corpus callosum (SCC) demonstrated the highest correlation particularly with walking speed (r=0.4, p<10(-4)), and in logistic regression it was the best regional predictor of low mobility performance. We also found that independent of mobility, corona radiata has the largest lesion burden with anterior (ACR) and posterior (PCR) aspects being the most frequently affected. The results suggest that compromised inter-hemispheric integration of visuospatial information through the SCC plays an important role in mobility impairment in the elderly. The relatively high lesion susceptibility of ACR and PCR in all subjects may obscure the importance of these lesions in mobility impairment.
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