Midline Splenial Lesion after Aneurysmal Subarachnoid Hemorrhage

Abstract

Background: Midline splenial lesion of the corpus callosum (MSCC) typically shows a diffusion restrictive pattern that is attributable to excitotoxic mechanisms. Recently, it has been reported in a variety of pathologic conditions. However, common pathophysiologic mechanisms of MSCC development are still lacking. We aimed to evaluate clinico-radiologic characteristics of patients with MSCC among those with aneurysmal subarachnoid hemorrhage (aSAH). Methods: We retrospectively reviewed consecutive patients who were diagnosed with aSAH. Patients without overt aneurysm on imaging study, who had poor quality or no MR image were excluded. MSCCs were divided into 2 groups (ovoid and extended) based on the morphological characteristics on diffusion-weighed image (DWI). Results: A total of 12 patients with aSAH had a MSCC on brain MR image. The median patient age was 62 years, and 25% were male. Eight of 12 patients had an ovoid shaped MSCC. Proportion of patients with parenteral nutrition, sodium imbalance and hypoglycemia were 58%, 42% and 8%, respectively. Half of patients with MSCC had a symptomatic vasospasm, cerebral edema and hydrocephalus. Furthermore, all the MSCC patients in the extended shape group had cerebral edema and hydrocephalus. Withdrawal or toxicity of antiepileptic drugs (AEDs) were not identified in any patients. All patients with an MSCC had a poor prognosis at 3 months. Conclusion: In patients with aSAH, MSCC is associated with the development of cerebral edema or hydrocephalus rather than AED withdrawal or toxicity. MSCC is possibly one of the poor prognostic signs in patients with aSAH. J Neurocrit Care 2015;8(2):78-84