Callosal Lesions Research Articles

Callosal lesion predicts future attacks after clinically isolated syndrome

Current MRI criteria can help predict a second attack after a clinically isolated syndrome (CIS). Given the known association between corpus callosum lesions (CC) and multiple sclerosis (MS), such lesions on MRI could provide additional predictive information. This study assessed whether the presence of CC lesion on MRI could, next to the modified Barkhof criteria, further enhance prediction of conversion from CIS to MS. Follow-up study of 158 patients with CIS who underwent MRI after CIS was performed. MRI were scored for the Barkhof criteria and CC lesion. Patients were classified as having MS according to Poser criteria. Cox regression models were used for the time to conversion from CIS to MS. The Barkhof criteria and CC lesion were strongly associated with conversion to MS with hazard ratios (HR), respectively, of 2.6 (95% confidence interval [CI] 1.5-4.3) and 2.7 (95% CI 1.6-4.5). The HRs of CC lesion adjusted for the Barkhof criteria and the Barkhof criteria adjusted for CC lesion were similar (HRs 1.8, not significant). The combined prediction of the Barkhof criteria and CC lesion was 3.3 (95% CI 1.9-5.7). Patients not fulfilling the Barkhof criteria had a fourfold increased risk of MS (HR 3.8, 95% CI 1.5-9.3) when they had a lesion in the CC. Corpus callosum (CC) lesion and the Barkhof criteria both predicted conversion to multiple sclerosis (MS). When both variables were combined, the association was stronger. The assessment of CC lesion may be a useful additional tool for predicting conversion to MS in patients with clinically isolated syndrome.

Perinatal exposure to music protects spatial memory against callosal lesions

Several studies have indicated that the exposure of rodents to music modulates brain development and neuroplasticity, by mechanisms that involve facilitated hippocampal neurogenesis, neurotrophin synthesis and glutamatergic signaling. This study focused on the potential protection that the perinatal exposure to music, between postnatal days 2 and 32, could offer against functional deficits induced by neonatal callosotomy in rats. The spontaneous alternation and marble-burying behaviors were longitudinally measured in callosotomized and control rats that had been exposed to music or not. The results indicated that the neonatal callosotomy-induced spontaneous alternation deficits that became apparent only after postnatal day 45, about the time when the rat corpus callosum reaches its maximal levels of myelination. The perinatal exposure to music efficiently protected the spontaneous alternation performance against the deficits induced by callosotomy. The present findings may offer important insights into music-induced neuroplasticity, relevant to brain development and neurorehabilitation.

Transiently reduced water diffusion in the corpus callosum in infants with benign partial epilepsy in infancy

Neuroimaging findings are usually normal in children with benign partial epilepsy in infancy. However, we found a transient reduction of water diffusion in the corpus callosum in two patients with probable benign partial epilepsy in infancy. The patients were admitted to our hospital because of seizure clusters. No delay in the developmental milestones was seen, and no neurological abnormalities were observed during the interictal period. Interictal electroencephalography was normal in both infants. However, the diffusion-weighted images showed abnormal high intensities in both the genu and splenium in one patient and in the splenium only in the other. No diffusion abnormalities were observed in follow-up magnetic resonance imaging. The clustered seizures may be related to the transient callosal lesions seen in our patients.

Occurrence of acute large and edematous callosal lesions in neuromyelitis optica

Background The corpus callosum is commonly involved in multiple sclerosis (MS), but the characteristics of callosal lesions in neuromyelitis optica (NMO) are unknown. Objective To reveal the features of callosal lesions in NMO in comparison to MS. Methods We retrospectively reviewed the medical records and the brain magnetic resonance imaging films of 56 patients with MS and 22 patients with NMO. Results In MS, 36 (64.3%) of 56 patients had callosal lesions, but only four patients had acute lesions. All such acute lesions were small, isolated and non-edematous, and the intensity was homotonic. Chronic lesions were observed in 34 patients with MS, and 32 (94%) of them presented small lesions located at the callosal lower margin (“hemi-oval pattern”). Meanwhile, four (18.2%) patients with NMO had callosal lesions, and three of them had acute lesions. Those acute lesions were multiple, large edematous ones with heterogeneous intensity (“marbled pattern”). In the chronic stage, the lesions shrank or disappeared. Conclusions Acute large, edematous callosal lesions occasionally occur in NMO. Similar to longitudinally extensive transverse myelitis, such callosal lesions may reflect severe edematous inflammation in NMO, and may provide additional evidence that the pathogenesis in NMO is different from that in MS.

Reversible Inferior Colliculus Lesion in Metronidazole-Induced Encephalopathy

This is to present reversible inferior colliculus lesions in metronidazole-induced encephalopathy, to focus on the diffusion-weighted imaging (DWI) and fluid attenuated inversion recovery (FLAIR) imaging. From November 2005 to September 2007, 8 patients (5 men and 3 women) were diagnosed as having metronidazole-induced encephalopathy (age range; 43-78 years). They had been taking metronidazole (total dosage, 45-120 g; duration, 30 days to 2 months) to treat the infection in various organs. Initial brain magnetic resonance imaging (MRI) were obtained after the hospitalization, including DWI (8/8), apparent diffusion coefficient (ADC) map (4/8), FLAIR (7/8), and T2-weighted image (8/8). Follow-up MRIs were performed on 5 patients from third to 14th days after discontinuation of metronidazole administration. Findings of initial and follow-up MRIs were retrospectively evaluated by 2 neuroradiologists by consensus, to analyze the presence of abnormal signal intensities, their locations, and signal changes on follow-up images. Initial MRIs showed abnormal high signal intensities on DWI and FLAIR (or T2-weighted image) at the dentate nucleus (8/8), inferior colliculus (6/8), corpus callosum (2/8), pons (2/8), medulla (1/8), and bilateral cerebral white matter (1/8). High-signal intensity lesions on DWI tended to show low signal intensity on ADC map (3/4), but in one patient, high signal intensity was shown at bilateral dentate nuclei on not only DWI but also ADC map. All the lesions in dentate, inferior colliculus, pons, and medullas had been resolved completely on follow-up MRIs in 5 patients, but in 1 patient of them, corpus callosal lesion persisted. Reversible inferior colliculus lesions could be considered as the characteristic for metronidazole-induced encephalopathy, next to the dentate nucleus involvement.

脳梁および近傍領域損傷による高次脳機能障害(<特集>側脳室腫瘍の診断と治療)

脳梁および近傍領域損傷による高次脳機能障害(<特集>側脳室腫瘍の診断と治療)

Interaction and communication between the cerebral hemispheres

Event Abstract Back to Event Interaction and communication between the cerebral hemispheres Giovanni Berlucchi1* 1 Universita di Verona, Dipartimento di Scienze Neurologiche e della Visione, Italy The corpus callosum is the main system of anatomical connection and functional interaction between the cerebral hemispheres of placental mammals. This review will first deal with classical and recent studies about the anatomy and physiology of the human corpus callosum in the light of direct knowledge of the characteristics of callosal neurons and their synaptic actions in animals. The topography within the human corpus callosum of fibers related to different cortical areas will be analyzed on the basis of studies with the diffusion tensor imaging technique and the imaging of changes in local blood flow within the white matter, complementing and qualifying knowledge about clinical deficits following partial callosal lesions in different locations. Finally, the different cognitive competences of the two hemispheres of the human brain after a callosal disconnection will be examined and extant non-callosal routes for hemispheric interaction will be discussed. Conference: 41st European Brain and Behaviour Society Meeting, Rhodes Island, Greece, 13 Sep - 18 Sep, 2009. Presentation Type: Oral Presentation Topic: Plenary lectures Citation: Berlucchi G (2009). Interaction and communication between the cerebral hemispheres. Conference Abstract: 41st European Brain and Behaviour Society Meeting. doi: 10.3389/conf.neuro.08.2009.09.001 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 04 Jun 2009; Published Online: 04 Jun 2009. * Correspondence: Giovanni Berlucchi, Universita di Verona, Dipartimento di Scienze Neurologiche e della Visione, Verona, Italy, giovanni.berlucchi@univr.it Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Giovanni Berlucchi Google Giovanni Berlucchi Google Scholar Giovanni Berlucchi PubMed Giovanni Berlucchi Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Differential Hand-neglect After a Callosal Lesion

The relationship between hemispatial neglect and callosal lesions is not fully understood. A 74-year-old woman exhibited destruction of the posterior part of the genu and the entire truncus of the corpus callosum and a part of the right cingulate sulcus after infarction of the right pericallosal artery. Three years after the infarction, severe left-sided unilateral spatial neglect was noted for the right hand and mild right-sided unilateral spatial neglect for the left hand. These findings are consistent with the model of right hemisphere dominance for spatial attention. The corpus callosum lesion itself could have been responsible for the patient's disconnection neglect.

Callosal lesions and delirious behavior during febrile illness

We retrospectively reviewed electroencephalography and magnetic resonance imaging findings for 21 children exhibiting delirious behavior during febrile illness. Among these, five patients had transient callosal lesions with or without white matter lesions on diffusion-weighted images. We compared the clinical characteristics, duration, and components of delirious behavior, the duration and severity of reduced consciousness, and EEG findings among patients with or without callosal lesions. No significant differences were detected in these items according to the presence or absence of callosal lesions. Adding insight into the pathogenesis of this condition, our study revealed that callosal lesions are not uncommon in patients exhibiting delirious behavior during febrile illness.

Magnetic resonance features of cerebral malaria

Cerebral malaria is a major health hazard, with a high incidence of mortality. The disease is endemic in many developing countries, but with a greater increase in tourism, occasional cases may be detected in countries where the disease in not prevalent. Early diagnosis and evaluation of cerebral involvement in malaria utilizing modern imaging modalities have an impact on the treatment and clinical outcome. To evaluate the magnetic resonance (MR) features of patients with cerebral malaria presenting with altered sensorium. We present the findings in three patients with cerebral malaria presenting with altered sensorium. MR imaging using a 1.5-Tesla unit was carried out. The sequences performed were 5-mm-thick T1-weighted, T2-weighted, fluid-attenuated inversion-recovery (FLAIR), and T2-weighted gradient-echo axial sequences, and sagittal and coronal FLAIR. Diffusion-weighted imaging was performed with b values of 0 and 1000 s/mm(2), and apparent diffusion coefficient (ADC) maps were obtained. Focal hyperintensities in the bilateral periventricular white matter, corpus callosum, occipital subcortex, and bilateral thalami were noticed on T2-weighted and FLAIR sequences. The lesions were more marked in the splenium of the corpus callosum. No enhancement on postcontrast T1-weighted MR images was observed. There was no evidence of restricted diffusion on the diffusion-weighted sequence and ADC map. MR is a sensitive imaging modality, with a role in the assessment of cerebral lesions in malaria. Focal white matter and corpus callosal lesions without any restricted diffusion were the key findings in our patients.

Diffusion weighted callosal integrity reflects interhemispheric communication efficiency in multiple sclerosis

We aimed to investigate the relation between damage in the corpus callosum and the performance on an interhemispheric communication task in patients with multiple sclerosis (MS). Relative callosal lesion load defined as the ratio between callosal area and the total lesion load in the total corpus callosum, and the diffusion tensor imaging (DTI) derived measures fractional anisotropy (FA) and transverse and longitudinal diffusivity were calculated in sixteen female MS patients and sixteen age and education matched female controls. The redundancy gain task was used to behaviorally evaluate interhemispheric communication efficiency. During this task, simple reaction times to uni- and bilateral presented stimuli are recorded. The advantage in reaction time for bilateral as compared to unilateral trials, the redundancy gain, was significantly larger for the MS-group. The DTI data showed significantly decreased FA and increased diffusivity parameters in the corpus callosum for the MS patients compared with the control group. Moreover, we found a significant correlation between the DTI-derived measures in the corpus callosum and the redundancy gain effect. Callosal damage in MS, as measured by DTI and defined as transverse diffusivity, is associated with alterations in a behavioral task that relies on interhemispheric transfer and communication.

Restricted Diffusion in the Splenium of the Corpus Callosum After Cardiac Arrest

The value of MRI findings for coma prognostication is a question of great clinical and pathological relevance. We describe MRI evidence of restricted diffusion in the splenium in 5 patients with coma after cardiopulmonary resuscitation following cardiac arrest. The most common clinical presentation of corpus callosum lesions (of any cause) is altered mental status, consistent with the global importance of these extensive inter-hemispheric fibers. In our four cases with bilateral splenium restricted diffusion, none of the patients recovered consciousness. One patient with a unilateral (likely embolic) restricted diffusion lesion had excellent recovery. In contrast to unilateral ischemic callosal lesions, we believe that generalized, midline splenium restricted diffusion occurring after cardiopulmonary arrest represents Wallerian degeneration of interhemispheric neurons rather than direct ischemic damage to the white matter or axons of the callosum and thus will likely portend a poor prognosis.

EEG Coherence for a Patient with Marchiafava-Bignami Disease

We evaluated a 39-year-old chronic alcoholic man with acute multiple cognitive impairment and callosal lesion seen in MRI, diagnosed as Marchiafava-Bignami disease (MBD), using analysis of electroencephalography (EEG) coherence. Three EEG sessions were recorded in the first week, the second and eighth month after disease onset in the MBD patient. Inter-hemispheric coherence (IhC), parasagittal coherence (PsC) and spatially averaged coherence (SAC) were computed. The results were compared with normative data from 30 age-matched healthy subjects. Mean values for IhC, PsC and SAC were significantly decreased during the acute stage of the disease (P < 0.01). The IhC values remained low (P < 0.01), however, PsC and SAC values rebounded in follow-up study. The IhC and SAC values were lowest in the frontal region, consistent with the main pathological involvement in the anterior two-thirds of the corpus callosum and early involvement of frontal cortex. In conclusion, MBD may manifest as a cerebral-disconnection state, which can be quantified using EEG-coherence analysis. EEG-coherence may serve as a useful tool for MBD diagnosis and evaluation.

Poster 315: Callosal Apraxia Without Callosal Lesion Following Multiple Embolic Infarcts in the Anterior Cerebral Artery Distribution: A Case Report

Poster 315 Callosal Apraxia Without Callosal Lesion Following Multiple Embolic Infarcts in the Anterior Cerebral Artery Distribution: A Case Report. Thomas S. Savadove, MD (Temple University/Moss Rehab, Philadelphia, PA); Ming K. Hsieh, MD. Disclosure: T.S. Savadove, None; M.K. Hsieh, None. Setting: Stroke unit in acute rehabilitation hospital. Patient: A 56-year-old woman with multiple bilateral anterior cerebral artery (ACA) infarcts. Case Description: The patient presented to the rehabilitation hospital after treatment for stroke. Magnetic resonance imaging showed multiple small acute infarcts in the bilateral ACA distribution, but no lesion in the corpus callosum. There were also prior infarcts in the right frontoparietal, left parietal, and left cerebellar regions, which had not affected upper-extremity function. Exam showed left hemiparesis (4/5). Right side was nonparetic (5/5) in the upper extremity. Left-hand grip was strong but the patient had impaired function on bimanual tasks. She was able to use the left hand given adequate stimulus (squeezing fingers), but had difficulty making spontaneous movements. She was unable to perform alternating movements. Assessment/Results: Intensive physical and occupational therapy improved function of the left hand. The patient developed markedly improved functional capacity with regard to bimanual activities of daily living such as dressing and eating. However, she remained unable to perform alternating movements with her hands, despite her functional gains. Discussion: This is callosal apraxia without a callosal lesion after embolic stroke involving numerous small ACA infarcts. As classically described, it affects only the left upper extremity despite involvement of both cerebral hemispheres. The lack of right upperextremity involvement precludes the diagnosis of sympathetic or left parietal apraxia. It presented a challenge in the rehabilitation of the patient, because integrated function between the 2 upper limbs was significantly impaired despite adequate strength and independent function of each side. Conclusions: Presence of a callosal apraxia may not be readily apparent when dealing with 1 or multiple ACA infarcts. This deficit requires more directed therapies to integrate the apractic left upper limb into functional activities despite the apparently mild impairments on that side.

Susac syndrome in a young child

Susac syndrome is a microangiopathy of unknown origin affecting the brain, retina and inner ear. This rare entity is often misdiagnosed as a demyelinating condition such as multiple sclerosis or acute disseminated encephalomyelitis. A high index of suspicion must be present as the majority of patients do not have the complete clinical triad at the time of onset of symptoms. The radiologist plays an important role when the disease is suspected and helps orient the investigations. The syndrome has characteristic imaging features on MRI that include multifocal white matter and occasional grey matter lesions, the corpus callosum being always involved. The predominant central callosal lesions, especially with rapid cystic transformation (central callosal holes) can be considered pathognomonic of this condition in the appropriate clinical setting. This disease is extremely rare in children. We report a case of Susac syndrome in a 9-year-old girl to increase the awareness among paediatric radiologists of this entity, which is usually not considered as a differential diagnosis of multifocal white matter involvement in this age group.

Dominant limb motor impersistence associated with callosal disconnection

Motor impersistence occurs more frequently after right than left hemispheric lesions. Following a callosal lesion, motor impersistence may thus occur more frequently in the right (dominant) than left limb. After an infarction involving the right medial frontal lobe and corpus callosum, a 66-year-old right-handed man demonstrated right limb motor impersistence on bedside evaluation, which was substantiated experimentally. Results demonstrated hemispatial effects with greater impersistence in the neglected (right) space.

Cortical Involvement of Marchiafava-Bignami Disease: A Case Report

Marchiafava-Bignami disease is a rare complication of chronic alcoholism and this malady typically manifests as callosal lesion. I report here on one patient with Marchiafava-Bignami disease (MBD) who has symmetric restricted diffusion in both lateral-frontal cortices, in addition to the callosal lesion.

Acute Marchiafava-Bignami Disease with Widespread Callosal and Cortical Lesions

Marchiafava-Bignami disease (MBD) is a rare alcohol-related disorder that results in progressive demyelination and necrosis of the corpus callosum. The process may extend to the optic chiasm and tracts, cerebellar peduncle, subcortical resion, neighboring white matter, and rarely, cortical gray matter. We report a case of MBD in which fluid-attenuated inversion recovery and diffusion magnetic resonance imaging studies revealed symmetrical hyperintense lesions in the cerebral cortex in addition to the callosal lesions.

Mixed alien hand syndrome coexisting with left‐sided extinction secondary to a left corpus callosal lesion: A case report

Alien hand syndrome (AHS) is actually two distinct syndromes with distinct clinical and anatomic features, that is, a frontal type and a callosal type. Frontal AHS occurs in the dominant hand; is associated with reflexive grasping, groping, and compulsive manipulation of tools. Callosal AHS is characterized primarily by intermanual conflict. We report a case of right frontal AHS and left callosal AHS (mixed AHS) secondary to ischemic stroke of the left corpus callosum (lesion extending from the genu to splenium) and right corpus callosum (minimal lesion in the splenium) in a 67-year-old male patient who also presented with left-sided tactile extinction. To our knowledge, rare reports have documented mixed AHS coexisting with nondominant side extinction secondary only to unilateral (left) callosal lesion, as in our case.

Acute Disseminated Encephalomyelitis in North Indian Children: Clinical Profile and Follow-Up

Acute disseminated encephalomyelitis in children is not uncommon in developing countries, yet there is little systematic documentation of its clinical profile and follow-up. We studied the clinical and neuroradiologic features of acute disseminated encephalomyelitis in 52 consecutive children. Clinical details, magnetic resonance imaging (MRI) findings, and the results of other investigations were recorded, and children were followed up from 6 to 48 months. A repeat MRI was done after 3 to 4 months, and in those with persistent lesions, another MRI was done after 6 to 7 months of discharge. The mean age at presentation was 6.14 +/- 3.17 years, 73.1% were male, and 17 children had a history of antecedent infectious illness or vaccination. Most children had a meningoencephalitic presentation, with sudden-onset motor weakness in 76.9% and seizures in 36.5%. Altered sensorium and pyramidal signs were seen in 55.8% and 80.7% of children, respectively. On MRI, scattered T(2)-weighted hyperintense lesions were seen, mainly in the subcortical white matter, especially in the parietal (53.8%) and frontal (30.17%) regions. Thalamic, basal ganglia, and callosal lesions were seen in 30.76%, 17.3%, and 13.46% of cases, respectively. Variable contrast enhancement was seen in 48% of those who had contrast MRIs. The response to methylprednisolone was good, with dramatic recovery in 26.9% and marked improvement in 51.9% at discharge. On follow-up, of 44 children, residual smaller MRI lesions were seen in 30. The MRI was repeated at 6 months in children with residual lesions, and it was found that the lesions either disappeared or were significantly reduced after 6 months in 75% of cases. Four children had relapse of acute disseminated encephalomyelitis with new lesions on MRI. All of them responded to methylprednisolone. None of the clinical or neuroradiologic factors at presentation had any significant correlation with relapse. Six months after discharge, no deficits could be found in 61.3% of cases; 15.9% and 4.5% had motor and cognitive deficits, and 9% had multiple deficits. The presentation of pediatric acute disseminated encephalomyelitis in developing countries is similar to that in developed countries. In spite of an aggressive presentation, most children respond well to corticosteroids. MRI lesions disappear or are significantly reduced at 6 months in the majority of cases.