A Pictorial Review on Reversible Splenial Lesions

Abstract

Splenium of corpus callosum can be involved in a variety of pathologies causing reversible or irreversible damage. Magnetic resonance imaging (MRI) is a useful investigation to evaluate the same. In spite of the differing etiologies implicated, MRI findings can be quite common. We review the reversible causes of diffusion restriction involving the splenium of corpus callosum and highlight the etiopathologic mechanisms implicated in these pathologies. We further discuss these pathologies in entirety with relevant clinical and laboratory findings helping make definitive diagnosis and guiding appropriate management.

“Reversible cytotoxic lesion of the corpus callosum following SARS-CoV-2 mRNA vaccine administration: a finding to be aware of”

“… 1 Cytotoxic lesions of the corpus callosum are caused by a long list of different factors that include antiepileptic drugs, withdrawal of antiseizure drugs, epilepsy, migraine with aura, trauma, viruses (Epstein-Barr virus, rotavirus, influenza, parainfluenza, measles, mumps, cytomegalovirus, varicella-zoster, human herpesvirus‐6, human herpesvirus‐7, adenovirus, human parvovirus B19, rubella, human immunodeficiency virus, and enterovirus), bacteria (Salmonella enteritidis, Staphylococcus aureus, Legionella pneumophila, Escherichia coli, Klebsiella pneumoniae, Mycoplasma pneumoniae, Streptococcus pneumoniae, Campylobacter jejuni, and Enterococcus faecalis), malaria parasite, dengue fever, Kawasaki disease, renal failure, hemolytic uremic syndrome, autoimmune diseases, radiation therapy, metabolic diseases, mumps vaccine, malignancy, subarachnoid hemorrhage, high-altitude cerebral edema, and several pharmacological and toxic substances. 1 - 2 , 7 It is important to notice that CLOCCs have been recently associated with COVID-19 and SARS-CoV-2 mRNA vaccine (BNT162b). 3 - 4 To our knowledge, this is the second case of CLOCCs after SARS-CoV-2 vaccination described in the literature.…”

Elevated risk for psychiatric outcomes in pediatric patients with Multisystem Inflammatory Syndrome (MIS-C): A review of neuroinflammatory and psychosocial stressors

“…As a result, the sustained lack of NMDARs may prevent glutamate from being taken from extracellular space, ultimately contributing to a sustained excess of glutamate in the synapse ( Manto et al, 2010 ). Additionally, hyperglutamatergia can help to explain the development of splenial lesions of the corpus callosum: glutamate may supplement the excitotoxic action of NMDARs, which in tandem with sodium-potassium channels, contribute to water flow into astrocytes and neurons in the corpus callosum and manifest in the hyperintensity seen in many MIS-C brain images ( Blaauw and Meiners, 2020 ; Sahu et al, 2021 ). This dysregulation in NMDARs has psychiatric implications: in a meta-analysis by Pearlman and colleagues, individuals with schizophrenia, schizoaffective, bipolar, or major depressive disorders were three times more likely than healthy controls to have elevated NMDAR antibody titers ( Pearlman and Najjar, 2014 ).…”

Unusual Lesion in the Splenium of the Corpus Callosum and COVID-19 Infection: A Case Report

“…Splenium lesions with reversible or irreversible damage may be encountered in many neurologic and non-neurologic diseases [ 2 , 3 ]. The CC is the largest thick commissural white matter bundle in the brain [ 3 ].…”

“…The CC is the largest thick commissural white matter bundle in the brain [ 3 ]. The splenium is the posterior part of the CC [ 2 ]. Unlike the major portion of the CC receiving its arterial supply from the carotid system, the splenium is supplied by the vertebrobasilar system [ 3 ].…”

“…Moreover, primary lesions can show contrast enhancement, which is very rarely present with CLOCCS [ 3 ]. Those lesions are generally reversible, and reversibility indicates a better prognosis [ 2 ].…”