Reversible cytotoxic edema in the splenium of the corpus callosum related to antiepileptic treatment: report of two cases and literature review.
OBJECTIVE
Clinically silent lesions localized in the splenium of the corpus callosum (SCC) are a rare finding in the magnetic resonance imaging (MRI) of patients receiving antiepileptic drugs (AEDs). They are usually of benign character but may induce unnecessary complementary examinations if their nature is unrecognized. So far, 22 cases have been described in the literature, for which different etiologies have been proposed. We describe two further cases and discuss the probable lesion etiology.


METHODS
We report two cases including a 25-year-old male patient and a 12-year-old female patient with a transient SCC lesion discovered in the context of a presurgical epilepsy evaluation.


RESULTS
Comprehensive MRIs, including diffusion tensor imaging-based fiber tracking of the lesion, revealed a cytotoxic edema not disrupting neuronal fibers. Serum arginine vasopressin (AVP) measurements revealed an altered secretion during the acute phase in one patient.


CONCLUSIONS
On the basis of our results, we hypothesize that the lesion consists of a cytotoxic edema, possibly induced by abrupt AED concentration changes and associated to alterations of AVP secretion.
Prilipko
Olga
O
Presurgical Epilepsy Evaluation Unit, Program of Functional Neurology and Neurosurgery of the University Hospitals of Lausanne and Geneva, Switzerland. olga.prilipko@hcuge.ch
Delavelle
Jacqueline
J
Lazeyras
Francois
F
Seeck
Margitta
M
D000293:Adolescent; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D001127:Arginine Vasopressin / Q000097:blood; D001929:Brain Edema / Q000097:blood / Q000139:chemically induced* / Q000473:pathology; D002648:Child; D003337:Corpus Callosum / Q000187:drug effects* / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D004827:Epilepsy / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male
D000927:Anticonvulsants; D001127:Arginine Vasopressin