Search

Dengue virus infection can cause a wide spectrum of clinical manifestations, ranging from mild fever to lethal dengue shock syndrome. Neurological manifestations include encephalitis, acute disseminated encephalomyelitis, Transverse myelitis, Guillain-Barre syndrome, and neuro-ophthalmic complications. We report a case of a 44-year-old male who was admitted to our hospital with high-grade fever, myalgia, retro-orbital pain, visual disturbances, and drowsiness. Hematological and serological parameters confirmed the diagnosis of dengue fever. Brain imaging demonstrated altered signal intensity in the splenium of the corpus callosum and eventually a diagnosis of a cytotoxic lesion of the corpus callosum (CLOCC) was made. The patient was managed conservatively and discharged 7 days after admission and imaging findings were resolved completely 3 weeks later.

Marchiafava-Bignami disease (MBD) is a rare vitamin B deficiency classically associated with alcoholism. MBD damages the corpus callosum and presents with nonspecific neurological symptoms. Radiological imaging is critical for diagnosing MBD and commencing subsequent treatment, which often consists of vitamin B supplementation. We present a case of MBD in a 56-year-old male with alcohol use disorder, epilepsy, schizophrenia, post-traumatic stress disorder, and cardiovascular risk factors. The patient presented with general neurological symptoms, and there were several potential diagnoses to consider based on the patient's history. Radiological imaging was necessary for diagnosis. This case demonstrates the role radiological imaging plays in the workup of MBD.

BackgroundTo determine whether restricted diffusion of the callosal splenium is specific for seizure activity in neonates.MethodsWe performed a retrospective chart review of 123 neonates who had a diagnosis of hypoxic ischemic encephalopathy (HIE) who underwent therapeutic cooling and had magnetic resonance imaging (MRI) within the first 10 days of life. The regions examined for injury include the callosal splenium, cortex, deep gray matter, and subcortical white matter. Neurodevelopmental outcomes were secondarily assessed using the Bayley Scales of Infant Development at 12 to 18 months of age and > 18 months of age. APGAR scores and pH, two important markers of hypoxia/ischemia and encephalopathy, were also analyzed in relation to these outcomes.ResultsApproximately 41% of the neonates had at least one abnormal region on brain MRI, and 21% had abnormal signal in the splenium. Clinical and/or electrographic seizures were documented in 32%. Changes in the splenium had a sensitivity of 54%, specificity of 94%, and positive predictive value of 81% for seizure presence. The presence of seizures and splenium lesion was associated poor developmental outcomes at 12 to 18 months of age. APGAR scores at 10 minutes, but not lowest pH was associated with splenial changes.ConclusionsRestricted diffusion of the callosal splenium is specific for recent seizures in neonates with HIE. Seizures and splenial lesion represent risk factors for poor neurodevelopmental outcomes. Child neurologists and neonatologists should consider splenial signal abnormality in their assessment of neonates at risk for seizures and counsel families about likely outcomes accordingly.

Cytotoxic lesions of the corpus callosum (CLOCCs) have broad differential diagnoses. Differentiating these lesions from lesions of vascular etiology is of high clinical significance. We compared the clinical and radiological characteristics and outcomes between vascular splenial lesions and CLOCCs in a retrospective cohort study. We examined the clinical and radiologic characteristics and outcomes in 155 patients with diffusion restriction in the splenium of the corpus callosum. Patients with lesions attributed to a vascular etiology (N = 124) were older (64.1 vs. 34.6 years old, p < 0.001) and had >1 vascular risk factor (91.1% vs. 45.2%, p < 0.001), higher LDL and A1c levels, and echocardiographic abnormalities (all p ≤ 0.05). CLOCCs (N = 31) more commonly had midline splenial involvement (p < 0.001) with only splenial diffusion restriction (p < 0.001), whereas vascular etiology lesions were more likely to have multifocal areas of diffusion restriction (p = 0.002). The rate of in-hospital mortality was significantly higher in patients with vascular etiology lesions (p = 0.04). Across vascular etiology lesions, cardio-embolism was the most frequent stroke mechanism (29.8%). Our study shows that corpus callosum diffusion restricted lesions of vascular etiology and CLOCCs are associated with different baseline, clinical, and radiological characteristics and outcomes. Accurately differentiating these lesions is important for appropriate treatment and secondary prevention. [ABSTRACT FROM AUTHOR]

Abstract Background To determine whether restricted diffusion of the callosal splenium is specific for seizure activity in neonates. Methods We performed a retrospective chart review of 123 neonates who had a diagnosis of hypoxic ischemic encephalopathy (HIE) who underwent therapeutic cooling and had magnetic resonance imaging (MRI) within the first 10 days of life. The regions examined for injury include the callosal splenium, cortex, deep gray matter, and subcortical white matter. Neurodevelopmental outcomes were secondarily assessed using the Bayley Scales of Infant Development at 12 to 18 months of age and > 18 months of age. APGAR scores and pH, two important markers of hypoxia/ischemia and encephalopathy, were also analyzed in relation to these outcomes. Results Approximately 41% of the neonates had at least one abnormal region on brain MRI, and 21% had abnormal signal in the splenium. Clinical and/or electrographic seizures were documented in 32%. Changes in the splenium had a sensitivity of 54%, specificity of 94%, and positive predictive value of 81% for seizure presence. The presence of seizures and splenium lesion was associated poor developmental outcomes at 12 to 18 months of age. APGAR scores at 10 minutes, but not lowest pH was associated with splenial changes. Conclusions Restricted diffusion of the callosal splenium is specific for recent seizures in neonates with HIE. Seizures and splenial lesion represent risk factors for poor neurodevelopmental outcomes. Child neurologists and neonatologists should consider splenial signal abnormality in their assessment of neonates at risk for seizures and counsel families about likely outcomes accordingly.

Introduction: Corpus callosum is the collection of white fibres situated in the longitudinal fissure of brain connecting the two halves of the brain. Different methodologies may yield different results in the measurement of diameters of corpus callosum. Aim: To find out any difference in corpus callosum diameters when these diameters were measured in formalin fixed brain specimens and in Magnetic Resonance Imaging (MRI) scans. Materials and Methods: This was a cross-sectional study carried out in the Department of Anatomy, Silchar Medical College and Hospital, Silchar, Assam, India from April 2014 to March 2019. A total of 107 formalin fixed cadaveric brain specimens were used to measure length, height and thickness of corpus callosum and MRI scans of 43 patients were used to measure the same diameters. The mean value of all the diameters of corpus callosum measured in formalin fixed brain specimens and in MRI scans were compared. Statistical significance was calculated with student’s t-test and p-value

Mild encephalitis/encephalopathy with reversible splenial lesion is a clinical and radiological diagnosis and is defined as reversible diffusion restriction in the corpus callosum splenium. It is generally reported to be related with viral infections. We present 2 adult patients with reversible diffusion restriction in the corpus splenium and mild encephalitis. Mild encephalitis/encephalopathy with reversible splenial lesion has a good prognosis, but the differential diagnosis should be made from ischemia, posterior reversible encephalopathy syndrome, lymphoma, diffuse axonal damage, and extrapontine myelinolysis. [ABSTRACT FROM AUTHOR]

Objective: Cytotoxic lesions of the corpus callosum (CLOCCs) are usually detected as a diffusion restriction in the splenium of the corpus callosum. They are rare secondary radiological findings associated with various clinical entities. The aim of this study is to evaluate the magnetic resonance imaging (MRI) findings and underlying clinical factors of cases with CLOCCs. Materials and Methods: The MRI images of 850 patients who were admitted to the emergency services between January 2017 and March 2021 with encephalopathy and epilepsy-like neurological complaints were scanned retrospectively. Twenty nine patients (20 men, 9 women) with CLOCCs were included in the study. Their radiological and clinical findings were evaluated. Results: The mean age was calculated as 26.4 years (5-72 years). The patients had neurological symptoms such as dysarthria, confusion, ataxia, syncope, epileptic seizure, and headache. Lesions were developed secondary to various infections in 20 (68.9%) patients. Diabetic decompensation was found in three patients and uremic decompensation in one patient. In the remaining patients, subarachnoid hemorrhage, asthma attack, trauma, high-dose lithium-levetiracetam intake and anti-epileptic drug withdrawal were responsible. Twenty patients had MRI control. In 16 (80%) patients, MRI findings returned to normal between 6 days and 8 months (median 30, Mean 53.8 days). One of the other 4 patients had partial regression, and 3 patients recovered with sequelae gliosis. Conclusion: CLOCCs are nonspecific MRI findings associated with a broad underlying clinical spectrum. They are usually reversible. Determination of the underlying clinical etiology, avoidance of an ischemic stroke and tumor-like misdiagnoses are important for appropriate patient management. [ABSTRACT FROM AUTHOR]

Dengue fever, the most common arboviral tropical disease, has shown a rapid increase in incidence over the last few decades. Increasing evidence of the various neurological manifestations in dengue has been documented in the literature. Patients positive for dengue on serology and with neurological manifestations were analysed and included in the present case series and brief review. The cases reveal a spectrum of neurological findings in dengue infection and include dengue haemorrhagic encephalitis, acute disseminated encephalomyelitis (ADEM), reversible splenial lesion syndrome (RESLES), intracranial haematoma, and posterior reversible encephalopathy syndrome (PRES), with a focus on the relevant imaging features. Contribution: The present case series emphasises the importance of understanding the relevant imaging findings and potential aetiopathogenesis of neurological involvement in dengue infected patients in order to make the correct diagnosis for effective treatment and improved outcome.

Transient lesions involving the splenium of corpus callosum is defined as reversible splenial lesion syndrome (RESLES). Benign convulsions with mild gastroenteritis is a rare condition which may be associated with RESLES. Since the prognosis is excellent, the awareness of this association is important to prevent unnecessary investigations and anti-epileptic drug therapy.

The understanding of neuroplasticity following stroke is predominantly based on neuroimaging measures that cannot address the subsecond neurodynamics of impaired language processing. We combined behavioral and electrophysiological measures and structural-connectivity estimates to characterize neuroplasticity underlying successful compensation of language abilities after left-hemispheric stroke. We recorded the electroencephalogram from patients with stroke lesions to the left temporal lobe and from matched controls during context-driven word retrieval. Participants heard lead-in sentences that either constrained the final word ("He locked the door with the") or not ("She walked in here with the"). The last word was shown as a picture to be named. Individual-participant analyses were conducted, focusing on oscillatory power as a subsecond indicator of a brain region's functional neurophysiological computations. All participants named pictures faster following constrained than unconstrained sentences, except for two patients, who had extensive damage to the left temporal lobe. Left-lateralized alpha-beta oscillatory power decreased in controls pre-picture presentation for constrained relative to unconstrained contexts. In patients, the alpha-beta power decreases were observed with the same time course as in controls but were lateralized to the intact right hemisphere. The right lateralization depended on the probability of white-matter connections between the bilateral temporal lobes. The two patients who performed poorly behaviorally showed no alpha-beta power decreases. Our findings suggest that incorporating direct measures of neural activity into investigations of neuroplasticity can provide important neural markers to help predict language recovery, assess the progress of neurorehabilitation, and delineate targets for therapeutic neuromodulation. Hum Brain Mapp 38:3151-3162, 2017. © 2017 Wiley Periodicals, Inc.

Cytotoxic lesion of the corpus callosum (CLOCC) stems from a variety of causes such as malignancies, drug treatments, metabolic disorders, subarachnoid hemorrhage, and infections, and often presents as encephalitis or encephalopathy. During this pandemic, we saw 2 cases with this lesion; the first one was a 42-year-old male who presented to the emergency department with complaints of headache, fever, and cough. There was a ground-glass opacity in the thorax computed tomography, and diffusion restriction was found in the corpus callosum splenium in the cranial magnetic resonance imaging (MRI) performed for headache that did not resolve with analgesic treatment during hospitalization due to the preliminary diagnosis of Coronavirus diseases-2019 (COVID-19) pneumonia. In the second case, Severe Acute Respiratory syndrome Coronavirus-2 polymerase chain reaction was found to be positive in the examinations performed during his admission to the emergency service due to weakness and presyncope, and diffusion restriction was observed in the corpus callosum splenium like the first case in cranial imaging. The follow-up cranial MRI was normal in both cases, so they were diagnosed with CLOCC. We aimed to report the present cases with COVID-19 associated CLOCC since they presented only as a headache and a presyncope without any mental deterioration.

Abstract Background MR fingerprinting (MRF) is a novel imaging method proposed for the diagnosis of Multiple Sclerosis (MS). This study aims to determine if MR Fingerprinting (MRF) relaxometry can differentiate frontal normal appearing white matter (F-NAWM) and splenium in patients diagnosed with MS as compared to controls and to characterize the relaxometry of demyelinating plaques relative to the time of diagnosis. Methods Three-dimensional (3D) MRF data were acquired on a 3.0T MRI system resulting in isotropic voxels (1 × 1 × 1 mm3) and a total acquisition time of 4 min 38 s. Data were collected on 18 subjects paired with 18 controls. Regions of interest were drawn over MRF-derived T1 relaxometry maps encompassing selected MS lesions, F-NAWM and splenium. T1 and T2 relaxometry features from those segmented areas were used to classify MS lesions from F-NAWM and splenium with T-distributed stochastic neighbor embedding algorithms. Partial least squares discriminant analysis was performed to discriminate NAWM and Splenium in MS compared with controls. Results Mean out-of-fold machine learning prediction accuracy for discriminant results between MS patients and controls for F-NAWM was 65 % (p = 0.21) and approached 90 % (p

Abstract Background Veiled by a myriad of monikers, there has been a growing recognition of cytotoxic lesions in the splenium of the corpus callosum as a distinct clinical entity. Despite the varied nomenclature, they all describe restricting callosal lesions on diffusion weighted magnetic resonance imaging with near-complete reversibility on therapy. The currently accepted terminology for these lesions is cytotoxic lesions of the corpus callosum (CLOCC). Only one case of CLOCC associated with cerebral venous Thrombosis has been reported in literature to date. Case presentation While these lesions have most commonly been linked to antiepileptic drug therapy, we describe a case of a young adult who developed CLOCC in the background of cerebral venous thrombosis. We hypothesize that occlusion of the posterior pericallosal vein led to the lesion in the splenium. Early institution of anticoagulation therapy resulted in complete reversal of the abnormality, leading to full clinical recovery. Conclusion Cytotoxic lesions of the corpus callosum may rarely be associated with cerebral venous thrombosis. We emphasize the need for greater awareness, early imaging and aggressive therapy of this potentially curable entity. We further highlight cerebral venous thrombosis as a cause for CLOCC.

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.

Introduction: Corpus callosum is the largest and most important of the forebrain commissural tracts connecting the two cerebral hemispheres. This white matter tract plays essential role in sensory, motor and cognitive signal transmission across the right and left cerebral hemispheres. Hence, corpus callosal thickness and morphology reflects the hemispheric volume and functional ability of the brain. Thinning of corpus callosum which can be due to abnormal or absent myelination, demyelinating conditions, hypoxic ischaemic encephalopathy and metabolic diseases affecting the white matter can lead to developmental impairment and behavioural disorders which need to be properly evaluated. Aim: To identify possible age-associated variability in the anteroposterior diameter and the thickness of different parts of the corpus callosum. Materials and Methods: A retrospective cross-sectional study of 420 patients over a period of two years from January 2019 to December 2020 done at Dr. PSIMS and RF, Gannavaram, Andhra Pradesh, India. Magnetic Resonance (MR) examinations were performed with 1.5T (Philips Healthcare) Magnetic Resonance Imaging (MRI) scanner. The subjects who underwent MRI for various suspected or known central nervous system diseases were included in the study. The thickness of various parts along with the anteroposterior diameter of the corpus callosum were measured with mid-sagittal T1 weighted MR sequence and the mean and standard deviation was calculated. Results: The anteroposterior diameter of the corpus callosum was more in older adults (61-70 years age group) than in children and younger adults. The mean thickness of genu, body and isthmus was found to be more in younger adults (21-30 years age group), whereas thickness of splenium was more in the age group of 31-40 years. Conclusion: The anteroposterior diameter was more in the elderly age group, whereas the thickness of corpus callosal regions was more in the young adult age group. Therefore, variations in corpus callosal thickness would help in the diagnosis of disease presence and progression.

Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) is a clinicoradiological entity characterized by mild encephalopathy with typical radiological findings. We report a case of 10-year-old male child who presented with abnormal body movements and altered consciousness. MRI revealed typical Middle Eastern respiratory syndrome (MERS) type II lesions. On follow-up, although patient improved clinically with reversal of MERS type II lesions; however, multiple punctuate blooming foci, suggesting microhemorrhages, were seen on imaging in bilateral cerebral hemispheres. This has not been documented yet and signifies a new spectrum of MERS.

We present a case of a woman who reported to the emergency unit due to recurrent episodes of severe headache and collapse. MRI examination revealed no relevant findings apart from small meningioma of the right parietal region. The patient was diagnosed with epilepsy and received outpatient treatment, which was changed due to poor toleration. A follow-up MRI was performed which revealed an isolated, focal lesion of the splenium of the corpus callosum. The patient underwent extensive laboratory testing and antiseizure medications were started again. Another MRI indicated substantial regression of the splenium of the corpus callosum (SCC) lesion. Both the complete clinical image and results of the diagnostic evaluation spoke in favor of cytotoxicity of the corpus callosum associated with anti-epileptic drug treatment. Pathologies involving the corpus callosum include congenital, demyelination, infection, neoplasm, trauma and vascular changes. Isolated, non-specific lesions of the splenium of corpus callosum usually indicate multiple sclerosis; however, other pathologies should be considered. Anti-epileptic drugs may evoke cytotoxic lesions of the corpus callosum (CLOCCs). [ABSTRACT FROM AUTHOR]

Background: MR fingerprinting (MRF) is a novel imaging method proposed for the diagnosis of Multiple Sclerosis (MS). This study aims to determine if MR Fingerprinting (MRF) relaxometry can differentiate frontal normal appearing white matter (F-NAWM) and splenium in patients diagnosed with MS as compared to controls and to characterize the relaxometry of demyelinating plaques relative to the time of diagnosis. Methods: Three-dimensional (3D) MRF data were acquired on a 3.0T MRI system resulting in isotropic voxels (1 × 1 × 1 mm3) and a total acquisition time of 4 min 38 s. Data were collected on 18 subjects paired with 18 controls. Regions of interest were drawn over MRF-derived T1 relaxometry maps encompassing selected MS lesions, F-NAWM and splenium. T1 and T2 relaxometry features from those segmented areas were used to classify MS lesions from F-NAWM and splenium with T-distributed stochastic neighbor embedding algorithms. Partial least squares discriminant analysis was performed to discriminate NAWM and Splenium in MS compared with controls. Results: Mean out-of-fold machine learning prediction accuracy for discriminant results between MS patients and controls for F-NAWM was 65 % (p = 0.21) and approached 90 % (p < 0.01) for the splenium. There was significant positive correlation between time since diagnosis and MS lesions mean T2 (p = 0.015), minimum T1 (p = 0.03) and negative correlation with splenium uniformity (p = 0.04). Perfect discrimination (AUC = 1) was achieved between selected features from MS lesions and F-NAWM. Conclusions: 3D-MRF has the ability to differentiate between MS and controls based on relaxometry properties from the F-NAWM and splenium. Whole brain coverage allows the assessment of quantitative properties within lesions that provide chronological assessment of the time from MS diagnosis. [ABSTRACT FROM AUTHOR]

Transient lesions involving the splenium of corpus callosum is defined as reversible splenial lesion syndrome (RESLES). Benign convulsions with mild gastroenteritis is a rare condition which may be associated with RESLES. Since the prognosis is excellent, the awareness of this association is important to prevent unnecessary investigations and anti-epileptic drug therapy. [ABSTRACT FROM AUTHOR]

Cytotoxic lesion of the corpus callosum (CLOCC) stems from a variety of causes such as malignancies, drug treatments, metabolic disorders, subarachnoid hemorrhage, and infections, and often presents as encephalitis or encephalopathy. During this pandemic, we saw 2 cases with this lesion; the first one was a 42-year-old male who presented to the emergency department with complaints of headache, fever, and cough. There was a ground-glass opacity in the thorax computed tomography, and diffusion restriction was found in the corpus callosum splenium in the cranial magnetic resonance imaging (MRI) performed for headache that did not resolve with analgesic treatment during hospitalization due to the preliminary diagnosis of Coronavirus diseases-2019 (COVID-19) pneumonia. In the second case, Severe Acute Respiratory syndrome Coronavirus-2 polymerase chain reaction was found to be positive in the examinations performed during his admission to the emergency service due to weakness and presyncope, and diffusion restriction was observed in the corpus callosum splenium like the first case in cranial imaging. The follow-up cranial MRI was normal in both cases, so they were diagnosed with CLOCC. We aimed to report the present cases with COVID-19 associated CLOCC since they presented only as a headache and a presyncope without any mental deterioration. [ABSTRACT FROM AUTHOR]

Introduction: Corpus Callosum (CC) is the major anatomical and functional commissure which transmits information across two cerebral hemispheres. It is assessed by looking at its morphology on midsagittal sequence of Magnetic Resonance Imaging (MRI). Physiological variations and diseases alter the structure of CC. It undergoes structural changes throughout the infancy which should be taken into account for better evaluation. Hence, the normal reference biometric data of CC on MRI in infants is needed. There are very limited data of normal reference range of thickness of CC especially in infants. Aim: To establish the normal standards for the CC in first year of life using MRI. Materials and Methods: It was a retrospective observational study conducted in the year 2019-2020 in which the MRI images of 100 patients aged 4 days to 12 months with seizures and trauma were reviewed to evaluate CC. Children with abnormalities on MRI were excluded from the study. The thickness of subregions of the CC (genu, body, splenium) and the length were measured. Age related changes in the size of the subregions of the CC was assessed. Data was entered in Microsoft Excel sheet and statistical analysis was done using SPSS software. Results: In the age group of less than two months, the width of genu, body, isthmus and splenium was 5 mm, 2 mm, 1.52 and 3.45 mm, respectively. The length of CC was 47.24 mm. As the age of children increased, there was increase in width of genu, body, splenium, isthmus and length of CC. At the age group of 11-12 months the width of genu, body, isthmus and splenium was 9.10 mm, 4.90 mm, 2.29 mm and 8.64 mm respectively. The length of CC was 60.57 mm. The study reveals that there is a progressive change in dimension of CC with advancement of age. Conclusion: There is a considerable change in the appearance of CC during infancy, knowledge of which is useful in differentiating between normal and abnormal brain.

Background: Veiled by a myriad of monikers, there has been a growing recognition of cytotoxic lesions in the splenium of the corpus callosum as a distinct clinical entity. Despite the varied nomenclature, they all describe restricting callosal lesions on diffusion weighted magnetic resonance imaging with near-complete reversibility on therapy. The currently accepted terminology for these lesions is cytotoxic lesions of the corpus callosum (CLOCC). Only one case of CLOCC associated with cerebral venous Thrombosis has been reported in literature to date. Case presentation: While these lesions have most commonly been linked to antiepileptic drug therapy, we describe a case of a young adult who developed CLOCC in the background of cerebral venous thrombosis. We hypothesize that occlusion of the posterior pericallosal vein led to the lesion in the splenium. Early institution of anticoagulation therapy resulted in complete reversal of the abnormality, leading to full clinical recovery. Conclusion: Cytotoxic lesions of the corpus callosum may rarely be associated with cerebral venous thrombosis. We emphasize the need for greater awareness, early imaging and aggressive therapy of this potentially curable entity. We further highlight cerebral venous thrombosis as a cause for CLOCC. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a rare disease characterized by a reversible lesion in the splenium of the corpus callosum (SCC) observed on MRI. The exact etiology of MERS is unknown, although infections and antiepileptic drugs have been reported as potential causes. Herein, we present the case of a 56-year-old male patient who experienced fever and headache for 3 days. He was referred to our hospital after symptomatic treatment by his primary care physician failed to improve his symptoms. The patient had no psychiatric symptoms or significant neurological findings. Head MRI revealed a high signal on SCC on diffusion-weighted imaging, raising the suspicion of MERS. All examinations to determine the cause of MERS were negative. The patient's symptoms improved with antibiotics and B complex vitamins. Upon admission, abdominal CT incidentally revealed a well-defined mass on the dorsal surface of the rectum suspected to be a tailgut cyst, warranting surgical resection. The cranial margin of the tumor was caudal to the third sacrum, and a trans-sacral approach was used for resection. The fifth sacrum and the coccyx were resected, and the tumor was resected without damaging the rectum. A histopathological examination revealed a mature teratoma without any malignancy. A follow-up CT at four months postoperatively showed no evidence of clinical recurrence of MERS. Adult-onset MERS is relatively rare, and no association with tumors has been reported. The association between encephalitis and teratomas includes ovarian teratomas, which cause anti-N-methyl-D-aspartate receptor encephalitis and paraneoplastic limbic encephalitis. Although the cause of MERS was unknown in this case, we report the coexistence of a sacral teratoma and MERS to contribute to the knowledge of the association between them., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research Ethics Committee of Koga Community Hospital issued approval 2024-2. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Fujimoto et al.)

Ideational slippage-characterized by incorrect word usage and strained logic during dialogue-is common in aging and, at greater frequency, is an indicator of pre-clinical cognitive decline. Performance-based assessment of ideational slippage may be useful in the study of cognitive aging and Alzheimer's-disease-related pathology. In this preliminary study, we examine the association between corpus callosum volume and a performance-based assessment of ideational slippage in middle-aged and older adults (age 61-79 years). Ideational slippage was indexed from cognitive special scores using the Rorschach Inkblot Method (RIM), which are validated indices of deviant verbalization and logical inaccuracy ( Sum6 , WSum6 ). Among middle-aged and older adults, smaller splenium volume was associated with greater ideational slippage (η p = 0.48), independent of processing speed and fluid intelligence. The observed negative associations are consistent with visuospatial perception and cognitive functions of the splenium. The effect was strongest with the splenium, and volumes of the genu and total white matter had small effects that were not statistically significant. Conclusions: Results are discussed with future application of RIM special scores for the assessment of pre-clinical cognitive decline and, based on observed effect sizes, power analyses are reported to inform future study planning.2 = 0.48), independent of processing speed and fluid intelligence. The observed negative associations are consistent with visuospatial perception and cognitive functions of the splenium. The effect was strongest with the splenium, and volumes of the genu and total white matter had small effects that were not statistically significant. Conclusions: Results are discussed with future application of RIM special scores for the assessment of pre-clinical cognitive decline and, based on observed effect sizes, power analyses are reported to inform future study planning.

We present a case of a woman who reported to the emergency unit due to recurrent episodes of severe headache and collapse. MRI examination revealed no relevant findings apart from small meningioma of the right parietal region. The patient was diagnosed with epilepsy and received outpatient treatment, which was changed due to poor toleration. A follow-up MRI was performed which revealed an isolated, focal lesion of the splenium of the corpus callosum. The patient underwent extensive laboratory testing and antiseizure medications were started again. Another MRI indicated substantial regression of the splenium of the corpus callosum (SCC) lesion. Both the complete clinical image and results of the diagnostic evaluation spoke in favor of cytotoxicity of the corpus callosum associated with anti-epileptic drug treatment. Pathologies involving the corpus callosum include congenital, demyelination, infection, neoplasm, trauma and vascular changes. Isolated, non-specific lesions of the splenium of corpus callosum usually indicate multiple sclerosis; however, other pathologies should be considered. Anti-epileptic drugs may evoke cytotoxic lesions of the corpus callosum (CLOCCs).

Abstract Background Dengue virus infection in humans can lead to a wide range of clinical manifestations, from mild fever to potentially fatal dengue shock syndrome. The incidence of dengue fever is on the rise in tropical countries. Due to the increasing incidence of dengue fever worldwide, atypical manifestations of the disease are increasingly reported. In this article we report a patient with dengue haemorrhagic fever who presented with reversible splenial lesion syndrome. Case presentation A 24-year-old Sri Lankan man who presented with fever and confusion was eventually diagnosed to have reversible splenial lesion syndrome based on brain imaging. Clinical, serological and haematological parameters confirmed a diagnosis of dengue haemorrhagic fever. His presentation, assessment, and management are described in this case report. Conclusion Reversible splenial lesion syndrome is a condition which is radiologically characterized by reversible lesion in the splenium of the corpus callosum. It is associated with infectious and non-infectious aetiologies. This case report highlights the occurrence of reversible splenial lesion syndrome as a presenting feature of the expanding list of unusual neurological manifestations of dengue infection.

Deficits in auditory and visual processing are commonly encountered by older individuals. In addition to the relatively well described age-associated pathologies that reduce sensory processing at the level of the cochlea and eye, multiple changes occur along the ascending auditory and visual pathways that further reduce sensory function in each domain. One fundamental question that remains to be directly addressed is whether the structure and function of the central auditory and visual systems follow similar trajectories across the lifespan or sustain the impacts of brain aging independently. The present study used diffusion magnetic resonance imaging and electrophysiological assessments of auditory and visual system function in adult and aged macaques to better understand how age-related changes in white matter connectivity at multiple levels of each sensory system might impact auditory and visual function. In particular, the fractional anisotropy (FA) of auditory and visual system thalamocortical and interhemispheric corticocortical connections was estimated using probabilistic tractography analyses. Sensory processing and sensory system FA were both reduced in older animals compared with younger adults. Corticocortical FA was significantly reduced only in white matter of the auditory system of aged monkeys, while thalamocortical FA was lower only in visual system white matter of the same animals. Importantly, these structural alterations were significantly associated with sensory function within each domain. Together, these results indicate that age-associated deficits in auditory and visual processing emerge in part from microstructural alterations to specific sensory white matter tracts, and not from general differences in white matter condition across the aging brain. [ABSTRACT FROM AUTHOR]

Posttraumatic cerebral infarction (PTCI) is a devastating complication of traumatic brain injury. It is usually seen in patients with moderate-to-severe head injury with a reported incidence of 1.9%–10.4%. Brain shift associated with the traumatic intracranial space-occupying lesions with or without severe cerebral edema is the most common mechanism underlying the PTCI. Without associated direct vascular injury, isolated PTCI is very rare after mild head injury. Such cases of PTCI following mild head injury have been reported in children in whom they usually affect the gangliocapsular region supplied by the lenticulostriate arteries. Such infarcts in adults are extremely rare. Although the exact pathogenesis is not clear, vasospasm or shearing-associated intimal tear is proposed to be the cause for this infarct. Other common causes of cerebral infarction should be ruled out before making such a diagnosis. Unlike PTCI associated with a severe head injury, cerebral infarction following mild head injury is expected to have a better neurological outcome. [ABSTRACT FROM AUTHOR]

Metamorphopsia is the visual misperception of the shape of objects. Retinal diseases, especially those affecting the macula, are responsible for the majority of cases. However, it can also be seen during migraine attacks, epileptic seizures and damage to visual pathways in the brain. Infarction in the splenium of the corpus callosum may cause visual agnosia, prosopometamorphopsia, alexia and amnesia. We describe here a case of isolated metamorphopsia caused by splenial infarction in the absence of any other neurological symptoms.

Background: Previous studies have documented a spectrum of brain magnetic resonance imaging (MRI) abnormalities in patients with cerebral malaria, but little is known about the prevalence of such abnormalities in patients with non-cerebral malaria. The aim of this study was to assess the frequency of brain MRI findings in returning travellers with non-cerebral malaria. Methods: A total of 17 inpatients with microscopically confirmed Plasmodium falciparum non-cerebral malaria underwent structural brain MRI at 3.0 Tesla, including susceptibility-weighted imaging (SWI). Presence of imaging findings was recorded and correlated with clinical findings and parasitaemia. Results: Structural brain abnormalities included a hyperintense lesion of the splenium on T2-weighted imaging (n = 3) accompanied by visible diffusion restriction (n = 2). Isolated brain microhaemorrhage was detected in 3 patients. T2-hyperintense signal abnormalities of the white matter ranged from absent to diffuse (n = 10 had 0–5 lesions, n = 5 had 5–20 lesions and 2 patients had more than 50 lesions). Imaging findings were not associated with parasitaemia or HRP2 levels. Conclusion: Brain MRI reveals a considerable frequency of T2-hyperintense splenial lesions in returning travellers with non-cerebral malaria, which appears to be independent of parasitaemia. [ABSTRACT FROM AUTHOR]

Background: Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinical-radiological entity, characterized by mild encephalitis or encephalopathy associated with a reversible lesion of the corpus callosum, which commonly involves the splenium. MERS with autoimmune thyroid disease has rarely been reported. Case Report: A 37-year-old man with Grave’s disease presented to our institution, with symptoms of confused mentality, visual hallucinations, headache, and fever. Because there was no other etiology for changed mentality, headache, and fever, except for elevated antithyroid antibodies (antimicrosomal antibodies, anti-thyroglobulin antibody, and thyrotropin binding inhibitor immunoglobulin) in the blood and mild pleocytosis in the CSF study, we diagnosed the case as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT). A hyperintense signal on T2-weighted images, a hypointense signal on T1-weighted images, and a non-enhancing lesion in the splenium of corpus callosum on initial magnetic resonance imaging (MRI) disappeared on follow-up MRI, which was compatible with the criteria of MERS. Conclusion: Although MRI images in autoimmune thyroid disease have usually been unremarkable, we report a case of MERS in SREAT.

Central neurocytomas (CNs) are rare intraventricular tumors that are well demarcated and display neuronal differentiation. This tumor type is most frequently diagnosed in young adults and is typically located at the septum pellucidum and fornix, and presents with intracranial hypertension due to obstructive hydrocephalus. Extraventricular neurocytomas (EVNs) are rare neuronal tumors with biological and histopathological characteristics similar to CNs, but which arise from the extraventricular parenchymal tissue (Giangaspero et al., 1997) Giangaspero et al. (1997) [4]. Extraventricular neurocytomas are included in the definition of neoplasms in the 2007 World Health Organization classification of tumors of the central nervous system [6]. These atypical locations are mostly in the cerebral hemispheres that are commonly identified in the frontal and parietal lobes. However, there have been some reports of EVNs located in the thalamus, cerebellum, pineal region, and even in the spinal cord (McCutchen et al., 1999; Stephan et al., 1999; Tortori-Donati et al. 1999) McCutchen et al. (1999), Stephan et al. (1999), Tortori-Donati et al. (1999) [7,13,14]. In this manuscript, we report an extremely rare case of an EVN arising from the splenium of the corpus callosum, and review the relevant literature and management of such lesions.

Background: Lesions to the posterior section of the corpus callosum, called the splenium, and the immediate area have been separately associated with perceived visual distortions of the face (prosopometamorphopsia) or difficulty reading (alexia). Case report: This case report describes a right-handed patient who complained of prosopometamorphopsia associated with the lower part of the face and alexia following infarction of the left splenium in the corpus callosum. Conclusions: The splenium and adjacent retrosplenial cortex facilitate the transfer of visual information and memory function between the two hemispheres of the brain and along the Papez circuit, respectively. We believe that damage to this singular area of the brain could bring about several concurrent yet disparate symptoms, such as the reported prosopometamorphopsia and alexia with this patient.

Sex is considered an understudied variable in health research. Schizophrenia is a brain disorder with known sex differences in epidemiology and clinical presentation. We systematically reviewed the literature for sex-based differences of diffusion properties of white matter tracts in schizophrenia. We then conducted a meta-analysis examining sex-based differences in the genu and splenium of the corpus callosum in schizophrenia. Medline and Embase were searched to identify relevant papers. Studies fulfilling the following criteria were included: (1) included individuals with a diagnosis of schizophrenia, (2) included a control group of healthy individuals, (3) included both sexes in the patient and the control groups, (4) used diffusion tensor imaging, and (5) involved analyzing metrics of white matter microstructural integrity. Fractional anisotropy (FA) was used as the measure of interest in the meta-analysis. Of 730 studies reviewed, 75 met the inclusion criteria. Most showed no effect of sex, however, those that did found either that females have lower FA than males, or that the effect of disease in females is larger than that in males. The findings of the meta-analysis in the corpus callosum supported this result. There is a recognized need for studies on schizophrenia with a sufficient sample of female patients. Lack of power undermines the ability to detect sex-based differences. Understanding the sex-specific impact of illness on neural circuits may help inform development of new treatments, and improvement of existing interventions. [ABSTRACT FROM AUTHOR]