Vertigo and Cytotoxic Lesions of the Corpus Callosum: Report with Review of the Literature.

John Rolshoven,Burton J Tabaac,Rolando Ania,Katelyn Fellows,Peter Berlit

doi:10.1155/2021/5573822

John Rolshoven, Burton J Tabaac + Show 3 more

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https://doi.org/10.1155/2021/5573822

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Abstract

Background The term cytotoxic lesions of the corpus callosum (CLOCCs) encompasses the entity reversible splenial lesion syndrome (RESLES). RESLES typically presents with altered levels of consciousness, seizures, and delirium and is distinguished radiographically by reversible focal lesions of the splenium of the corpus callosum. This disease pathology is associated with withdrawal of antiepileptic medications, infections, metabolic disturbance, or high-altitude cerebral edema. Methods We presented an otherwise healthy 72-year-old female that was consulted for an episode of isolated vertigo lasting four hours. Initial workup included CT head without contrast, CT angiogram head and neck, and MRI brain with and without contrast. The patient experienced recurrent episodes of vertigo at one and four months after initial presentation. An extensive workup at one month included a wide spectrum of laboratory tests and repeat imaging. Results Noncontrast CT of the head and CT angiogram of the head and neck were reassuring. MRI brain with and without contrast demonstrated hyperintensity in the splenium of the corpus callosum on FLAIR sequencing. A follow-up visit at one month revealed vitamin B12 deficiency and unchanged hyperintensity of the splenium of the corpus callosum. History and workup were negative for typical risk factors associated with RESLES. Conclusion An otherwise healthy patient who presented with an isolated episode of vertigo was discovered to demonstrate radiographic features consistent with RESLES but lacked the common risk factors and typical presentation of RESLES. This case expands the possible clinical presentation of RESLES and highlights the possible relationship between vitamin B12 deficiency and radiographic features of RESLES.

Highlights

Posterior Reversible Encephalopathy Syndrome, PRES, is characterized by the presence of white and gray matter changes, with a suggestion of vasogenic edema in the posterior occipital and parietal lobes, in conjunction with acute neurological symptoms [1]
We present a case highlighting the typical radiographic finding suggestive of reversible splenial lesion syndrome (RESLES)
Our patient had a thirty-year history of severe, recurrent bouts of vertigo of varying severity. e patient lacked the typical associated risk factors of RESLES

Summary

Introduction

Posterior Reversible Encephalopathy Syndrome, PRES, is characterized by the presence of white and gray matter changes, with a suggestion of vasogenic edema in the posterior occipital and parietal lobes, in conjunction with acute neurological symptoms [1]. Other notable areas of involvement include the cerebellum and brainstem Both PRES and a cerebral infarction may affect the posterior regions, sparing of the calcarine and paramedian regions of the occipital lobe are typical with posterior cerebral infarction. Symptoms of RESLES are often associated with an underlying condition, with common symptoms including mildly altered states of consciousness, delirium, and seizures [4]. RESLES is characterized radiographically by T2 diffusion-weighted hyperintensity in the splenium of the corpus callosum. Like PRES, clinical presentation for RESLES can be highly variable, with common symptoms inclusive of mildly altered states of consciousness, delirium, and seizures. While most cases spontaneously resolve, patients for whom a poor prognosis is portended include those that present with acute onset of severe disturbance of consciousness, evidence of extracallosal lesions, and/or with neuroelectrographic (EEG) changes [6]

Case Presentation

Discussion