Boomerang sign: Clinical significance of transient lesion in splenium of corpus callosum (original) (raw)
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Kafkas Journal of Medical Sciences
Although rare, splenium of the corpus callosum (SCC) may be involved in many etiological conditions. Most forms of involvement are permanent and minorities of these are transient. The pathophysiology is intra-myelinic axonal edema related to hyponatremia and local inflammatory cell infiltration. The first case; 34-years-old female patient accepted to our unit with recurrent complex-partial seizures. She had epilepsy for 10 years and carbamazepine using for 4 years. Second case; 22-years-old female patient presented with vomiting, nausea and visual deficiency. Both cases magnetic resonance imaging (MRI) showed focal diffusion limitation in SCC. A comprehensive diagnostic work-up was carried out to account for these clinical and neuro-radiological presentations. 1-month follow up MRI showed resolution of these lesions. Previously, transient limitation of diffusion of SCC has been mostly reported in epileptic patients and treatment with anti-epileptic agents. However, many other conditions may result the appearance of similar clinical states. These patients may have mild form of encephalopathy and the prognosis is generally good. MRI is particularly sensitive in early identification of these lesions. A good understanding of the transient nature of the condition may allow avoidance from unnecessary invasive diagnostic and therapeutic methods.
Focal transient lesion in the splenium of the corpus callosum in three non-epileptic patients
Neuroradiology, 2006
Introduction We analyzed the imaging features of transient focal lesions in the splenium of the corpus callosum (SCC) in non-epileptic patients receiving antiepileptic drugs (AEDs). Methods We identified signal abnormalities in the SCC in three non-epileptic patients, all of them receiving AEDs. We examined two of these patients with multiplanar magnetic resonance (MR) imaging using 1.0-T equipment including fluid-attenuated inversion recovery (FLAIR), T2-weighted (TSE) and T1-weighted (SE) sequences before and after injection of contrast agent. The third patient was studied using 1.5-T equipment with the same sequences. Additionally, a T1 SE sequence with a magnetization transfer contrast pulse off resonance (T1 SE/MTC), diffusion-weighted imaging (EPI-DWI) and apparent diffusion coefficient (ADC) maps were obtained. Results We observed an identical pattern of imaging abnormalities in all patients characterized by round lesions, hyperintense on FLAIR and hypointense on T1 SE images, located in the central portion of the SCC. One lesion showed homogeneous gadolinium enhancement and perilesional vasogenic edema. This particular lesion showed restricted diffusion confirmed on the ADC map. This pattern was considered consistent with focal demyelination. Follow-up MR examinations showed complete disappearance or a clear reduction in lesion size. All patients had been treated with AEDs, but they did not show any clinical signs of toxicity, interhemispheric symptoms, or abnormal neurological findings (including seizures). Conclusion We believe that our MR findings might be interpreted as transient lesions related to AED toxicity. They presumably resulted from focal demyelination in the central portion of the SCC.
Brain and Development, 2008
A transient lesion in the splenium of the corpus callosum is a rare disease and its pathogenesis is unclear. We performed simultaneous diffusion-weighted magnetic resonance images and brain blood perfusion scintigraphy for a transient lesion in the splenium of the corpus callosum. This transient lesion showed hyperintensity on the diffusion-weighted images and hypointensity on the apparent diffusion coefficient map. However, normal blood perfusion was observed on brain blood perfusion scintigraphy. Transient axonal or intramyelinic edema might be a cause of the transient lesion in the splenium of the corpus callosum.
Acta Radiologica, 2005
Transient focal lesions of splenium of corpus callosum can be seen as a component of many central nervous system diseases, including antiepileptic drug toxicity. The conventional magnetic resonance (MR) findings of the disease are characteristic and include ovoid lesions with high signal intensity at T2-weighted MRI. Limited information exists about the diffusion-weighted MRI characteristics of these lesions vanishing completely after a period of time. We examined the conventional, FLAIR, and diffusion-weighted MR images of a patient complaining of depressive mood and anxiety disorder after 1 year receiving antiepileptic medication.
AJNR. American journal of neuroradiology, 1999
Discrete focal lesions in the splenium of the corpus callosum on MR images in epileptic patients have received little attention in the literature. Our purpose was to describe these lesions, which may be related to the toxicity of antiepileptic drugs (AEDs), and to discuss the possible mechanisms of their development. We examined six patients with epilepsy whose brain MR imaging findings showed a discrete focal nonhemorrhagic lesion in the splenium of the corpus callosum. The medical records and MR images were reviewed retrospectively with respect to the patients' clinical history, medication, and laboratory findings to determine the etiology of the lesion. In all six patients MR imaging showed a focal lesion in the splenium of the corpus callosum, which was ovoid in shape and 15 to 19 mm in size. In the three patients who received contrast material, there was no enhancement of the lesion. Four of six patients had a history of medication with dilantin, in two of whom the level of...
Reversible Splenial Lesion of the Corpus Callosum
Australasian Psychiatry, 2008
Introduction: Migraine with aura has long been believed to be related to the phenomenon of cortical spreading depression. Clinically, there are no consistent neuroimaging findings corresponding to an attack of migraine with aura. Case Report: We describe a patient suffering from migraine with aura associated with a transient abnormality in the midline of the splenium of the corpus callosum, showed by a magnetic resonance imaging. Features of edema and restricted diffusion indicated that there was cytotoxic edema. Conclusions: There have been reports of various etiologies associated with a temporary focal lesion in the splenium of the corpus callosum manifested as obviously restricted diffusion. These findings may be the consequence of a high vulnerability of the splenium of the corpus callosum to cytotoxic damage. Migraine with aura was considered to be the cause of the reversible focal injury of the splenium in this case. This association has not been reported earlier.
Callosal Disconnection Syndrome in Transient Splenial Lesion of the Corpus Callosum
A 64-year-old male patient presented with fever, agitation, and flu-like symptoms as well as difficulty in using his hands simultaneously. The brain magnetic resonance imaging (MRI) showed a solitary lesion in the splenium of the corpus callosum (SCC). The detailed neuropsychological examination revealed signs of disturbed interhemispheric transfer. The diagnosis of encephalitis was supported by the acute onset of brain dysfunction and the inflammatory changes of the cerebrospinal fluid (CSF). The clinical and MRI abnormalities completely recovered within one week without any treatment. In previously published reports of reversible focal lesions of the SCC, neuropsychological symptoms have rarely been reported. Our case underlines the importance of targeted neuropsychological examination in detecting callosal dysfunction and exemplifies the spontaneously benign prognosis of SCC.