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IMAGES IN NEUROLOGY |
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| Year : 2008 | Volume
: 11
| Issue : 2 | Page : 123-124 |
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Transient and reversible focal lesion involving the splenium of the corpus callosum in a person with epilepsy
Nitin C Parikh, Makarand Kulkarni
Department of Radiodiagnosis, Lilavati Hospital and Research Center, Bandra (W), Mumbai, India
Correspondence Address:
Nitin C Parikh
Paramount Diagnostic and Research Center, Near Natubhai Center, Gotri Road, Vadodara, Gujarat
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0972-2327.41883
How to cite this article:
Parikh NC, Kulkarni M. Transient and reversible focal lesion involving the splenium of the corpus callosum in a person with epilepsy. Ann Indian Acad Neurol 2008;11:123-4 |
How to cite this URL:
Parikh NC, Kulkarni M. Transient and reversible focal lesion involving the splenium of the corpus callosum in a person with epilepsy. Ann Indian Acad Neurol [serial online] 2008 [cited 2023 Feb 2];11:123-4. Available from: https://www.annalsofian.org/text.asp?2008/11/2/123/41883 |
 Case Report | |  |
A 40-year-old man with epilepsy was admitted with relapse of generalized tonic-clonic seizures following inadvertent discontinuation of phenytoin that he had been taking regularly. His neurological examination and previous brain magnetic resonance imaging (MRI) were normal. A repeat MRI (1.5-Tesla superconducting magnet, Symphony, Siemens, Germany) of the brain, using axial T1-weighted spin-echo (500 TR / 11 TE), axial and sagittal T2-weighted turbo spin-echo (6000 TR / 90 TE), axial FLAIR, and diffusion-weighted and ADC sequences, revealed a solitary well-defined ovoid lesion in the splenium of the corpus callosum, measuring 15 × 20 mm in size. The lesion was isointense to minimally hypointense on T1-weighted sequences, hyperintense on T2-weighted and FLAIR sequences, and showed restricted diffusion with low ADC values (40-50) [Figure 1a-c]. Axial, sagittal, and coronal T1-weighted sequences were obtained after intravenous injection of gadolinium (0.1 mmol/kg gadopentetate dimeglumine). Postcontrast MRI showed no significant enhancement of the lesion [Figure 1d]. The rest of the brain parenchyma was normal. The patient became asymptomatic after resuming phenytoin. An MRI of the brain, repeated after 4 weeks, revealed complete disappearance of the splenial lesion. He remained normal 6 months later.
| Discussion | | |
Discrete focal nonhemorrhagic lesions within the central portion of the splenium of the corpus callosum without any other accompanying lesion frequently pose a diagnostic dilemma for the clinician. [1] It is important to be aware that reversible focal lesions can occur rarely after seizures. Reversible MR signal changes in the splenium can occur due to vasogenic edema following a seizure, [1],[2],[3] withdrawal of an antiepileptic drug, [1],[2],[4],[5],[6] antiepileptic drug toxicity, [1] multiple sclerosis, trauma, infarct, neoplasm, adrenoleukodystrophy and other leukodystrophies, AIDS dementia complex, Marchiafava-Bignami disease, [1],[7] or childhood-onset anorexia nervosa. [8] Reversible splenial signal changes due to vasogenic edema can occur in acute herpes simplex cerebellitis. [9],[10] It is hypothesized that these signal changes may be related to alteration in the arginine-vasopressin system [3] or exitotoxic injury to astrocytes. [2],[11]
A similar lesion was observed in a patient with an episode of kaleidoscopic vision while using diet pills containing sympathomimetic drugs [12] ; withdrawal of the medication resulted in the cessation of the episodes and normalization of the MRI.
| References | | |
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| 12. | Winslow H, Mickey B, Frohman EM. Sympathomimetic-induced kaleidoscopic visual illusion associated with a reversible splenium lesion. Arch Neurol 2006;63:135-7. [PUBMED] [FULLTEXT] |
[Figure 1a-c], [Figure 1d]
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