Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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April 11, 2011
Reversible Focal Splenial Lesion
- These are well-circumscribed lesions located in the median/paramedian aspect of the splenium of corpus callosum.
- Most common causes are viral encephalitis, anti-epileptic drug toxicity or withdrawal, and hypoglycemia.
- Patients present with visual simultanagnosia (hemialexia, unilateral agraphia, and possible unilateral apraxia. Other reported symptoms include seizures, confusion, ataxia, drowsiness, coma, headache and delirium.
- Key Diagnostic Features: These lesions are hyperintense on diffusion-weighted imaging (DWI) with corresponding low signal on the apparent-diffusion coefficient (ADC) maps confirming restricted diffusion. This is thought to reflect cytotoxic edema without brain ischemia. Follow-up studies demonstrate resolution of restricted diffusion.
- DDx: ADEM, multiple sclerosis, brain ischemia, Marchiafava-Bignami disease, lymphoma
- Treatment: Treating the primary condition is helpful; steroids can be used.
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