Annals of Indian Academy of Neurology
IMAGES IN NEUROLOGY
Year
: 2008  |  Volume : 11  |  Issue : 2  |  Page : 123--124

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




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;11:123-124


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 2022 Oct 2 ];11:123-124
Available from: https://www.annalsofian.org/text.asp?2008/11/2/123/41883


Full Text

 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

1Kim SS, Chang KH, Kim ST, Suh DC, Cheon JE, Jeong SW, et al. Focal lesion in the splenium of the corpus callosum in epileptic patients: Antiepileptic drug toxicity? AJNR Am J Neuroradiol 1999;20:125-9.
2Moritani T, Smoker WR, Sato Y, Numaguchi Y, Westesson PL. Diffusion-weighted imaging of acute excitotoxic brain injury. Am J Neuroradiol 2005;26:216-28.
3Cohen-Gadol AA, Britton JW, Jack CR Jr, Friedman JA, Marsh WR. Transient postictal magnetic resonance imaging abnormality of the corpus callosum in a patient with epilepsy: Case report and review of the literature. J Neurosurg 2002;97:714-7.
4Honda K, Nishimiya J, Sato H, Munakata M, Kamada M, Iwamura A, et al. Transient splenial lesion of the corpus callosum after acute withdrawal of antiepileptic drug: A case report. Magn Reson Med Sci 2006;5:211-5.
5Gürtler S, Ebner A, Tuxhorn I, Ollech I, Pohlmann-Eden B, Woermann FG. Transient lesion in the splenium of the corpus callosum and antiepileptic drug withdrawal. Neurology 2005;65:1032-6.
6Hakyemez B, Erdogan C, Yildirim N, Gokalp G, Parlak M. Transient splenial lesion of corpus callosum associated with antiepileptic drug: Conventional and diffusion-weighted magnetic resonance images. Acta Radiol 2005;46:734-6.
7Georgy BA, Hesselink JR, Jernigan TL. MR imaging of the corpus callosum. AJR Am J Roentgenol 1993;160:949-55.
8Nishimura K, Takei N, Suzuki K, Kawai M, Sekine Y, Isoda H, et al. A transient lesion in splenium of the corpus callosum in a patient with childhood-onset anorexia nervosa. Int J Eat Disord 2006;39:527-9.
9Kato Z, Kozawa R, Teramoto T, Hashimoto K, Shinoda S, Kondo N. Transient lesion in the splenium of the corpus callosum in acute cerebellitis. J Child Neurol 2003;18:291-2.
10Kizilkilic O, Karaca S. Influenza-associated encephalitis-encephalopathy with a reversible lesion in the splenium of the corpus callosum: Case report and literature review. AJNR Am J Neuroradiol 2004;25:1863-4.
11Hassel B, Boldingh KA, Narvesen C, Iversen EG, Skrede KK. Glutamate transport, glutamine synthetase and phosphate-activated glutaminase in rat CNS white matter: A quantitative study. J Neurochem 2003;87:230-7.
12Winslow H, Mickey B, Frohman EM. Sympathomimetic-induced kaleidoscopic visual illusion associated with a reversible splenium lesion. Arch Neurol 2006;63:135-7.