Transient lesion in the splenium of the corpus callosum in status migrainosus.

Abstract

A 10-year-old Caucasian boy presented to the pediatric emergency room with continuous severe bitemporal throbbing headache, photophobia, phonophobia and vomiting for 7 days. He also endorsed some intermittent right leg and foot numbness. He was diagnosed with migraine without aura 6 months back fulfilling the required criteria of the International Classification of Headache Disorders, 3rd edition. His intermittent headaches prior to this presentation were easily controlled with nonsteroidal antiinflammatory drugs. There was no history of fever, concussion or any other sick symptoms. MRI of brain revealed focal area of restricted diffusion in the splenium of the corpus callosum with corresponding T2 and flair hyperintensity (Fig. 1a, b). During further evaluation, repeat brain MRI next day showed resolution of the restricted diffusion but T2 and flair hyperintensity persisted. Laboratory tests including hemogram and basic metabolic panel including renal function and serum electrolytes were within normal limits. MR angiography of the brain, extensive stroke workup and EEG were unremarkable. The patient was treated with IV ketorolac and valproic acid with prompt resolution of headache. He was started on low dose of amitriptyline. Follow-up MRI at 3 months showed interval resolution of the long TR signal abnormality also. Followup over 3 years showed only one to two episodes of easily controllable migrainous headache each month. Transient splenial lesions (TSL) are oval homogeneous, non-hemorrhagic and non-enhancing lesions over the central part of the splenium. This entity was first described in 1996 in association with epilepsy [1]. Afterward, reversible splenial lesion has been described with other varied etiologies, including sudden withdrawal of antiepileptic drugs,