Cytotoxic lesion of the corpus callosum in a patient with aphasic status epilepticus

  • Juan Ignacio Castiglione Neurology department, Fleni, Buenos Aires, Argentina
  • Mario Emiliano Ricciardi Neurology department, Fleni, Buenos Aires, Argentina
  • Catalina Bensi Neurology department, Fleni, Buenos Aires, Argentina

Abstract

A 47-year-old man with a history of aphasic seizures presented to the emergency room with a 12-hour global aphasia. Upon admission, brain MRI did not reveal acute lesions, and EEG showed sharp waves in the left frontal-temporal region. An Aphasic Status Epilepticus was diagnosed and antiepileptic treatment was initiated with adequate response. A week after the episode, a new brain MRI showed a high-signal ovoid lesion on T2-weighted and FLAIR sequences in the central part of the splenium of the corpus callosum. On diffusion-weighted images (DWI) the lesion was hyperintense with decreased apparent diffusion coefficient (ADC) values, indicating restricted diffusion consistent with a cytotoxic lesion of the corpus callosum (CLOCC). Follow-up MRI one month later showed complete image resolution. CLOCCs are secondary lesions associated with various entities in which high levels of cytokines and extracellular glutamate cause intracellular edema and reduced diffusion, a condition called cytotoxic edema, which affects vulnerable brain regions such as the splenium of the corpus callosum. In epileptic patients, CLOCCs may be due to the effect of seizures, especially prolonged ones, as well as antiepileptic treatment itself. CLOCCs are rare radiological findings and must be recognized to avoid misdiagnosis.

Keywords: Corpus callosum, Citotoxic edema, MRI, Restricted diffusion, Epilepsy

References

Takayama H, Kobayashi M, Sugishita M, Mihara B. (2000). Diffusion-weighted imaging demonstrates transient cytotoxic edema involving the corpus callosum in a patient with diffuse brain injury. Clin Neurol Neurosurg, 102(3), 135-9. doi: 10.1016/s0303-8467(00)00079-2.

Conti M, Salis A, Urigo C, Canalis L, Frau S, Canalis GC.(2007). Transient focal lesion in the splenium of the corpus callosum: MR imaging with an attempt to clinical-physiopathological explanation and review of the literature. Radiol Med, 112(6), 921-35. doi: 10.1007/s11547-007-0197-9.

Starkey J, Kobayashi N, Numaguchi Y, Moritani T. (2017). Cytotoxic Lesions of the Corpus Callosum That Show Restricted Diffusion: Mechanisms, Causes, and Manifestations. Radiographics, 37(2):562-576. doi: 10.1148/rg.2017160085.

Tetsuka S. (2019). Reversible lesion in the splenium of the corpus callosum. Brain and behavior, 9(11), e01440. https://doi.org/10.1002/brb3.1440

Prilipko O, Delavelle J, Lazeyras F, Seeck M. (2005). Reversible cytotoxic edema in the splenium of the corpus callosum related to antiepileptic treatment: report of two cases and literature review. Epilepsia 46(10), 1633-6. doi: 10.1111/j.1528-1167.2005.00256.x.

Polster T, Hoppe M, Ebner A. (2001). Transient lesion in the splenium of the corpus callosum: three further cases in epileptic patients and a pathophysiological hypothesis. J Neurol Neurosurg Psychiatry. 70(4), 459-63. doi: 10.1136/jnnp.70.4.459.

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Published
2020-12-07
How to Cite
Castiglione, J., Ricciardi, M. E., & Bensi, C. (2020). Cytotoxic lesion of the corpus callosum in a patient with aphasic status epilepticus. Journal of Applied Cognitive Neuroscience, 1(1), 98-100. Retrieved from https://revistascientificas.cuc.edu.co/JACN/article/view/3313