Splenium Of The Corpus Callosum Lesions Research Articles

Treatment-related transient splenial lesion of the Corpus Callosum in patients with neuropsychiatric disorders: a literature overview with a case report

ABSTRACTIntroduction: 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.

Reversible lesion in the splenium of the corpus callosum.

Aim of ReviewThe presence of isolated, reversible lesions in the splenium of the corpus callosum (SCC) is essential to confirm the diagnosis of mild encephalitis/encephalopathy. The lesions usually heal within a month after the onset of neurological symptoms. Magnetic resonance imaging (MRI) has increasingly been used as a diagnostic tool, which has led to the publication of an increasing number of case reports. These have highlighted some inconsistencies about encephalitis/encephalopathy. First, the condition is not always mild and may be severe. Second, reversible lesions in the SCC have been identified in various diseases and conditions other than viral encephalitis/encephalopathy. Third, lesions in SCC are not always completely reversible. On this note, this review describes the specific clinical and radiological features of encephalitis/encephalopathy.FindingsThe reversible lesion in SCC is an MRI finding observable in a wide variety of diseases and conditions. Thus, it should be considered as a secondary change rather than a peculiar feature associated with mild encephalitis/encephalopathy. If reversible lesions are present in the SCC, the symptoms and prognosis are not necessarily favorable, with manifestations of encephalitis/encephalopathy varying from absent to severe. Neuroradiological features that appear as isolated high‐intensity signals on diffusion‐weighted images and a decreased apparent diffusion coefficient of the lesion might indicate a diagnosis of cytotoxic edema. Findings of previous studies suggest that cytokine‐mediated cytotoxic edema of the SCC may be an important pathophysiological manifestation of this condition.ConclusionThe reversible lesions in the SCC found on MRI are not exclusive to encephalitis/encephalopathy but may be secondary to other disorders.

Value of Magnetic Resonance Imaging Findings in Differential Diagnosis between the Adult Reversible Splenial Lesion Syndrome and Ischemic Infarction of the Splenium of the Corpus Callosum

Objective To evaluate the magnetic resonance imaging (MRI) findings in differential diagnosis between the adult reversible splenial lesion syndrome (RESLES) and ischemic infarction of the splenium of the corpus callosum (SCC). Methods The MRI findings and clinical data of 7 RESLES patients and 13 patients with ischemic infarction of SCC who were clinically diagnosed and treated in our center from May 2015 to June 2017 were analyzed retrospectively. The main MRI findings included location,morphology,signal intensity,maximum cross-sectional area,diffusion weighted imaging (DWI),and apparent diffusion coefficient (ADC) value. Results On the MRI findings of 7 RESLES patients (5 males and 2 females),the centers of all lesions of the SCC were located in the midline of SCC,the lesion shapes were round,ellipse,or spindle,and the distribution of the lesions was bilateral and symmetric as the center of the midline of SCC. The lesions were hyperintense on DWI,and the mean maximum cross-sectional area of lesions was (56.9±32.6) mm2 and the mean ADC value was (0.3963±0.0715) ×10-3 mm2/s. On the review MRI,all the lesions disappeared (mean interval:10 days). On the MRI findings of 13 patients with ischemic infarction of SCC (10 males and 3 females),the lesions were irregular or patchy in shape and were almost laterally and asymmetrically distributed. The lesions were hyperintense on DWI,and the mean maximum cross-sectional area was (55.1±43.9) mm2 and the mean ADC value was (0.4978±0.0123) ×10-3 mm2/s. The mean maximum cross-sectional area (t=0.096,P=0.925) and the ADC value (t=-1.988,P=0.062) were not significantly different between RESLES group and ischemic infarction of SCC group. Conclusions The location,morphology,and distribution of the SCC lesions and the co-existence of other lesions in the brain are helpful for the differential diagnosis between RESLES and ischemic infarction of SCC. However,the mean maximum cross-sectional area and the ADC value show no obvious difference between these two diseases.

Transient splenial lesion in patient with malignant neuroleptic syndrome

Abstract A 23-year-old woman presented with abnormal behavior and hallucinations. She has received continuous treatment for bipolar disorder over the last two years. Within 7 days of the onset of symptoms the patient became catatonic, with hyperthermia up to 41 °C. The brain MRI showed high signal intensity on the T2-weighted and FLAIR sequences in the splenium of the corpus callosum (SCC). A second MRI two weeks later showed a complete resolution of SCC lesion. The patient was given a course of electroconvulsive therapy and recovered completely from her neurological symptoms in two months after the onset of symptoms. Reversible corpus callosum syndrome in patients with catatonia should be considered in differential diagnosis.

Reversible Splenial Lesion in Postpartum Cerebral Angiopathy: A Case Report

Reversible lesions on magnetic resonance imaging that transiently restrict diffusion in the splenium of the corpus callosum (SCC) without any other accompanying lesions have been reported in various clinical conditions. We offer the first report of postpartum cerebral angiopathy with reversible SCC lesions.

Reversible Splenial Lesion Syndrome in Pediatric Systemic Lupus Erythematosus: Figure 1.

Transient lesions involving the splenium of the corpus callosum — reversible splenial lesion syndrome (RESLES) or mild encephalitis/encephalopathy with a reversible isolated splenium of the corpus callosum lesion (MERS) — have been described in patients with encephalopathy of various etiologies but rarely in systemic lupus erythematosus (SLE), limited to a case series of 3 patients1,2,3 …

Transient splenial lesion of the corpus callosum in a case of benign convulsion associated with rotaviral gastroenteritis

Transient magnetic resonance (MR) signal changes in the splenium of the corpus callosum (SCC) arise from many different conditions, including encephalopathy or encephalitis caused by infection, seizures, metabolic derangements, and asphyxia. Few case reports exist on reversible SCC lesions associated with rotavirus infection. A benign convulsion with mild gastroenteritis (CwG) is frequently associated with rotaviral infections. This entity is characterized by normal laboratory findings, electroencephalogram, neuroimaging, and good prognosis. We report a case of a 2.5-year-old Korean girl with rotavirus-associated CwG demonstrating a reversible SCC lesion on diffusion-weighted MR images. She developed 2 episodes of brief generalized tonic-clonic seizure with mild acute gastroenteritis without any other neurologic abnormality. Stool test for rotavirus antigen was positive. Brain MRI done on the day of admission showed a linear high signal intensity and decreased apparent diffusion coefficient values on the SCC. The lesion completely disappeared on follow-up MRI 6 days later. The patient fully recovered without any sequelae.

Reversible splenial lesion syndrome in neuroleptic malignant syndrome

BackgroundReversible focal lesions in the splenium of the corpus callosum (SCC) or reversible splenial lesion syndrome are rare and little is known about their pathophysiology.Case summaryThe authors describe a case of a 65-year-old female who presented with fever, abnormal behaviour and mild hypernatremia. She was on neuropsychiatric treatment for bipolar disorder but denied any history of seizure. After an extensive workout to exclude infection, a clinical diagnosis of neuroleptic malignant syndrome (NMS) was made. Initial magnetic resonance imaging (MRI) of the brain showed a lesion in the SCC characterized by high-signal intensity on T2-weighted and FLAIR sequences with reduced signal intensity on T1-weighted sequence. Diffuse weighted imaging (DWI) showed restricted diffusion. There was no enhancement following Gadolinium administration. The follow-up MRI 8 weeks later showed complete resolution of the SCC lesion.ConclusionWhile the pathophysiology of reversible SCC lesions is still unclear, this case highlights the need to consider NMS in the differential diagnosis of reversible splenial lesion of the corpus callosum.

Transient lesion in the splenium related to antiepileptic drug: Case report and new pathophysiological insights

Transient focal lesions in the splenium of the corpus callosum (SCC) have been associated with antiepileptic drug (AED) treatment. However, the aetiology is widely unknown. We describe a transient SCC lesion in an epilepsy patient after abrupt AED reduction. Whole head high-field diffusion tensor imaging (DTI) including fully automated quantitative fractional anisotropy (FA) analysis was used to get insight into the pathophysiology of transient SCC lesions. Our results demonstrate that a reversible loss of directional fibre organisation in the splenium, likely due to intramyelinic oedema, is the morphological correlate of transient SCC lesions. We conclude that DTI provides a highly sensitive and quantitative tool to detect subtle and transient loss of fibre integrity associated with AED treatment.

Reversible focal splenial lesions

Reversible focal lesions in the splenium of the corpus callosum (SCC) have recently been reported. They are circumscribed and located in the median aspect of the SCC. On MRI, they are hyperintense on T2-W and iso-hypointense on T1-W sequences, with no contrast enhancement. On DWI, SCC lesions are hyperintense with low ADC values, reflecting restricted diffusion due to cytotoxic edema. The common element is the disappearance of imaging abnormalities with time, including normalization of DWI. Clinical improvement is often reported. The most established and frequent causes of reversible focal lesions of the SCC are viral encephalitis, antiepileptic drug toxicity/withdrawal and hypoglycemic encephalopathy. Many other causes have been reported, including traumatic axonal injury. The similar clinical and imaging features suggest a common mechanism induced by different pathological events leading to the same results. Edema and diffusion restriction in focal reversible lesions of the SCC have been attributed to excitotoxic mechanisms that can result from different mechanisms; no unifying relationship has been found to explain all the pathologies associated with SCC lesions. In our opinion, the similar imaging, clinical and prognostic aspects of these lesions depend on a high vulnerability of the SCC to excitotoxic edema and are less dependent on the underlying pathology. In this review, the relevant literature concerning reversible focal lesions in the SCC is analyzed and hypotheses about their pathogenesis are proposed.

Reversible splenial lesion with restricted diffusion in a wide spectrum of diseases and conditions: Report of eight additional cases and literature review

Reversible lesion in the central area of the splenium of the corpus callosum (SCC) is a unique phenomenon occurring particularly in patients with encephalitis or encephalopathy and in patients receiving antiepileptic drugs (AED). We report MR imaging findings, clinical courses, and outcomes in eight patients with various diseases and conditions. Eight patients with a reversible SCC lesion with transiently restricted diffusion were reviewed retrospectively. Diseases and conditions that were associated with a reversible lesion included epilepsy receiving AED (n=1), seizure from eclampsia receiving AED (n=1), mild infectious encephalitis (n=2), hypernatremia resulting in osmotic myelinolysis (n=1), and neoplasm (n=3) such as acute lymphocytic leukemia, spinal meningeal melanocytoma, and esophageal cancer. We evaluated MR imaging findings and clinical findings. Seven patients had isolated SCC lesions; one patient with osmotic myelinolysis showed additional parenchymal lesions. The reversible SCC lesion shape was oval (n=6) or extended (n=2). The mean apparent diffusion coefficient value of the splenial lesion was 0.40+/-0.16 x 10-3 mm2/s, ranging from 0.22 to 0.64 x 10-3 mm2/s. In a patient with osmotic myelinolysis, additional white matter lesions, shown as restricted diffusion, were revealed as not reversible on follow-up MR imaging. Neurological courses and outcomes were good in seven patients with isolated SCC lesions, but poor in one with osmotic myelinolysis. Reversible SCC lesion with restricted diffusion is apparent in a wide spectrum of diseases and conditions. Neurological courses and outcomes are good, particularly in patients with isolated SCC lesions. Knowledge of MR imaging findings and the associated spectrum of diseases and conditions might prevent unnecessary invasive examinations and treatments.

A transient lesion in splenium of the corpus callosum in a patient with childhood‐onset anorexia nervosa

Although a transient lesion in the splenium of the corpus callosum (SCC) has been reported predominantly regarding patients with epilepsia, it is of rare occurrence, and its underlying biological basis remains unknown. This is a report of an SCC lesion in a patient with anorexia nervosa (AN). The patient was a 15-year-old girl with childhood-onset (11 years) and a protracted course of AN. On admission, the patient showed no apparent neurological abnormalities. Magnetic resonance imaging (MRI) scans revealed a circumscribed lesion in the SCC. We treated her with nutritional rehabilitation supplemented with B vitamins. One month later, the lesion completely disappeared, but her weight was not restored. Treatment with B-vitamin supplementation may be beneficial for the treatment of patients with AN, in cases in which the disorder develops at an early age before brain maturation (i.e., childhood-onset cases), along with an enduring course of malnutrition.

Transient Splenial Lesion of the Corpus Callosum after Acute Withdrawal of Antiepileptic Drug: A Case Report

Transient lesions at the splenium of the corpus callosum (SCC) have been reported after withdrawal of specific antiepileptic drugs (AED), though the pathophysiology of the lesions remains unclear. We examined and treated a schizophrenic patient who developed a transient SCC lesion after withdrawal of the AED, carbamazepine. Interestingly, the SCC lesion was accompanied by the onset of diabetes insipidus, a state of arginine-vasopressin (AVP) insufficiency. Because carbamazepine is shown to potentiate the effect of AVP, our case suggests that an insufficiency of AVP followed by withdrawal of AED could contribute to the pathogenesis of a transient SCC lesion.

Transient Focal Lesions in the Splenium of the Corpus Callosum with Restricted Diffusion: An Enigma

Small transient lesions in the central part of the splenium of the corpus callosum (SCC) have been reported in MR examinations, particularly in patients with encephalitis or encephalopathy, and in patients with or without epilepsy who are receiving antiepileptic drugs. The MR findings are characteristic: an ovoid T2-high signal lesion in the SCC, no enhancement after contrast agent, restricted diffusion shown by diffusion MR imaging, and complete disappearance on follow-up MR examinations. Most noteworthy is that these lesions have restricted diffusion but are reversible, which is distinct from infarction lesions seen in energy failure. The exact mechanism of these transient lesions remains uncertain and enigmatic. We review previously reported patients to show these unique MR findings and describe possible pathogenesis of particular SCC lesions. Keywords: magnetic resonance imaging, diffusion-weighted imaging, splenium of corpus callosum, epilepsy, antiepileptic drug, encephalitis/encephalopathy

Reversible Cytotoxic Edema in the Splenium of the Corpus Callosum Related to Antiepileptic Treatment: Report of Two Cases and Literature Review

Clinically silent lesions localized in the splenium of the corpus callosum (SCC) are a rare finding in the magnetic resonance imaging (MRI) of patients receiving antiepileptic drugs (AEDs). They are usually of benign character but may induce unnecessary complementary examinations if their nature is unrecognized. So far, 22 cases have been described in the literature, for which different etiologies have been proposed. We describe two further cases and discuss the probable lesion etiology. We report two cases including a 25-year-old male patient and a 12-year-old female patient with a transient SCC lesion discovered in the context of a presurgical epilepsy evaluation. Comprehensive MRIs, including diffusion tensor imaging-based fiber tracking of the lesion, revealed a cytotoxic edema not disrupting neuronal fibers. Serum arginine vasopressin (AVP) measurements revealed an altered secretion during the acute phase in one patient. On the basis of our results, we hypothesize that the lesion consists of a cytotoxic edema, possibly induced by abrupt AED concentration changes and associated to alterations of AVP secretion.

Transient Edematous Lesions of the Splenium in Epileptic Patients

Transient focal lesions in the splenium of the corpus callosum (SCC) have been previously described in patients with epilepsy or without epilepsy but receiving antiepileptic drugs (AED). Two epileptic patients were admitted to our long-term monitoring unit. Antiepileptic drugs were completely discontinued a few days later. One patient had no seizures. The other had three attacks, the last of which occurred two days before a brain magnetic resonance imaging (MRI) was performed. In both cases brain MRI showed a lesion in the SCC characterized by high signal on T2-weighted images and no enhancement after Gadolinium infusion. The patients were discharged with their pre-admission medications. A follow-up MRI five weeks later showed resolution of the SCC lesions. The pathogenesis of transient SCC lesions in epileptic patients is still unclear. In our patients, either the sudden AED withdrawal or the seizures activity may be presumed to be the cause, though an individual susceptibility must also be considered.

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion

To clarify whether patients with clinical diagnoses of encephalitis/encephalopathy with a reversible lesion in the splenium of the corpus callosum (SCC) share common clinical features. Possible encephalitis/encephalopathy patients with a reversible isolated SCC lesion on MRI were collected retrospectively. Their clinical, laboratory, and radiologic data were reviewed. Fifteen encephalitis/encephalopathy patients with a reversible isolated SCC lesion were identified among 22 patients referred for this study. All 15 patients had relatively mild clinical courses. Twelve of the 15 patients had disorders of consciousness. Eight patients had seizures, and three of them received antiepileptic drugs. All 15 patients clinically recovered completely within 1 month (8 patients within a week) after the onset of neurologic symptoms. The SCC lesion was ovoid in six patients; it extended irregularly from the center to the lateral portion of SCC in the other eight patients. Homogeneously reduced diffusion was seen in all seven patients who underwent diffusion-weighted imaging. There was no enhancement in the five patients so examined. The SCC lesion had completely disappeared in all patients at follow-up MRI exams between 3 days and 2 months after the initial MRI (within 1 week in eight patients). The clinical features among the affected patients were nearly identical, consisting of relatively mild CNS manifestations and complete recovery within 1 month.