Boomerang sign: Clinical significance of transient lesion in splenium of corpus callosum

Malhotra, Hardeep Singh; Garg, Ravindra Kumar; Vidhate, Mukund R; Sharma, Pawan Kumar

doi:10.4103/0972-2327.95005

Cited by 45 publications

(19 citation statements)

References 22 publications

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“…16 The finding of transient signal changes of the splenium of the corpus callosum is a feature that might be seen in demyelinating or vascular conditions. 24,25 Preservation of U-fibers in diffuse white matter disease has diagnostic utility. 16 Alexander disease, metachromatic leukodystrophy, and Xlinked adrenoleukodystrophy are the most notable disorders with this distinctive feature.…”

Section: Discussionmentioning

confidence: 99%

Brain MR Imaging Findings in Woodhouse-Sakati Syndrome

Abusrair¹,

Bohlega²,

Alsemari³

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Woodhouse-Sakati syndrome is a rare autosomal recessive disorder characterized by hypogonadism, alopecia, diabetes mellitus, and progressive extrapyramidal signs. The disease is caused by biallelic pathogenic variants in the DCAF17 gene. The purpose of this study was to describe the spectrum of brain MR imaging abnormalities in Woodhouse-Sakati syndrome. MATERIALS AND METHODS: We reviewed brain MR images of 26 patients with a clinical and genetic diagnosis of Woodhouse-Sakati syndrome (12 males, 14 females; age range, 16-45 years; mean age, 26.6 years). Follow-up studies were conducted for 6 patients. RESULTS: All patients had abnormal MR imaging findings. The most common abnormalities were a small pituitary gland (76.9%), pronounced basal ganglia iron deposition (73%), and white matter lesions in 69.2%. White matter lesions showed frontoparietal and periventricular predominance. All white matter lesions spared subcortical U-fibers and were nonenhanced. Prominent perivascular spaces (15.3%) and restricted diffusion in the splenium of the corpus callosum (7.6%) were less frequent findings. Follow-up studies showed expansion of white matter lesions with iron deposition further involving the red nucleus and substantia nigra. Older age was associated with a more severe degree of white matter lesions (P Ͻ .001). CONCLUSIONS: Small pituitary gland, accentuated iron deposition in the globus pallidus, and nonenhancing frontoparietal/periventricular white matter lesions were the most noted abnormalities seen in our cohort. The pattern and extent of these findings were observed to correlate with older age, reflecting a possible progressive myelin destruction and/or axonal loss. The presence of pituitary hypoplasia and white matter lesions can further distinguish Woodhouse-Sakati syndrome from other neurodegenerative diseases with brain iron accumulation subtypes. ABBREVIATIONS: NBIA ϭ neurodegenerative diseases with brain iron accumulation; WSS ϭ Woodhouse-Sakati syndrome; SNHL ϭ sensorineural hearing loss

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Section: Discussionmentioning

confidence: 99%

Brain MR Imaging Findings in Woodhouse-Sakati Syndrome

Abusrair¹,

Bohlega²,

Alsemari³

et al. 2018

AJNR Am J Neuroradiol

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“…Transient reversible restricted diffusion within the splenium of the corpus callosum is a known radiological finding in various conditions that includes neonatal seizures, hemolytic-uremic syndrome with encephalopathy, neonatal hypoglycemia, antiepileptic drug therapy, epilepsy, viral encephalitis, demyelination disorders, and many other conditions. [567891011]…”

Section: Introductionmentioning

confidence: 99%

Restricted diffusion in the corpus callosum: A neuroradiological marker in hypoxic–ischemic encephalopathy

Kale

Joshi

Kelkar

2016

Indian Journal of Radiology and Imaging

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Background:Restricted diffusion within the splenium of the corpus callosum has been described by other authors in various conditions, however, restricted diffusion in the entire corpus callosum or isolated involvement of the splenium, genu, or body has been infrequently reported on magnetic resonance imaging (MRI) in neonatal hypoxic–ischemic encephalopathy. We report a series of cases showing different patterns of involvement.Methods and Materials:Perinatal imaging with MRI including diffusion-weighted imaging was performed in 40 neonates with hypoxic–ischemic encephalopathy, including 11 premature neonates. Sixteen out of 40 patients demonstrated restricted diffusion within the corpus callosum. Out of 16 patients, 9 showed restricted diffusion in the entire corpus callosum, 4 had isolated splenium involvement, 2 had body and splenium signal abnormality, and 1 showed diffusion restriction only in the genu.Conclusions:Changes in the corpus callosum were also associated with more severe clinical presentation of encephalopathy. Restricted diffusion within the corpus callosum in infants with hypoxic–ischemic encephalopathy is often associated with extensive brain injury and appears to be an early neuroradiologic marker of adverse neurologic outcome.

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“…One of them (Case 5) demonstrated lesions in splenium of corpus callosum, a finding never reported before in either heroin or methadone intoxication. This finding may be a transient lesion of splenium and has been associated with various clinical conditions such as seizures, metabolic disturbances, infections, CNS malignancy, and drugs and toxins (antidepressants, antiepileptics, antipsychotics, chemotherapy agents, and pesticides) [15,[28][29][30][31][32][33][34][35][36][37][38]. We also had a single patient (case 8) who showed involvement of the globus pallidus and head of caudate nuclei.…”

Section: Discussionmentioning

confidence: 93%

Methadone-induced encephalopathy: a case series and literature review

et al. 2020

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Background: Accidental ingestion or consumption of supra-therapeutic doses of methadone can result in neurological sequelae in humans. We aimed to determine the neurological deficits of methadone-poisoned patients admitted to a referral poisoning hospital using brain magnetic resonance (MR) and diffusion weighted (DW) imaging. Methods: In this retrospective study, brain MRIs of the patients admitted to our referral center due to methadone intoxication were reviewed. Methadone intoxication was confirmed based on history, congruent clinical presentation, and confirmatory urine analysis. Each patient had an MRI with Echo planar T1, T2, FLAIR, and DWI and apparent deficient coefficient (ADC) sequences without contrast media. Abnormalities were recorded and categorized based on their anatomic location and sequence. Results: Ten patients with abnormal MRI findings were identified. Eight had acute-and two had delayed-onset encephalopathy. Imaging findings included bilateral confluent or patchy T2 and FLAIR high signal intensity in cerebral white matter, cerebellar involvement, and bilateral occipito-parietal cortex diffusion restriction in DWI. Internal capsule involvement was identified in two patients while abnormality in globus pallidus and head of caudate nuclei were reported in another. Bilateral cerebral symmetrical confluent white matter signal abnormality with sparing of subcortical U-fibers on T2 and FLAIR sequences were observed in both patients with delayed-onset encephalopathy. Conclusions: Acute-and delayed-onset encephalopathies are two rare adverse events detected in methadoneintoxicated patients. Brain MRI findings can be helpful in detection of methadone-induced encephalopathy.

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Boomerang sign: Clinical significance of transient lesion in splenium of corpus callosum

Cited by 45 publications

References 22 publications

Brain MR Imaging Findings in Woodhouse-Sakati Syndrome

Brain MR Imaging Findings in Woodhouse-Sakati Syndrome

Restricted diffusion in the corpus callosum: A neuroradiological marker in hypoxic–ischemic encephalopathy

Methadone-induced encephalopathy: a case series and literature review

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