Reversible splenial lesion with restricted diffusion in a wide spectrum of diseases and conditions.
OBJECTIVE
Reversible lesion in the central area of the splenium of the corpus callosum (SCC) is a unique phenomenon occurring particularly in patients with encephalitis or encephalopathy and in patients receiving antiepileptic drugs (AED). We report MR imaging findings, clinical courses, and outcomes in eight patients with various diseases and conditions.


METHODS
Eight patients with a reversible SCC lesion with transiently restricted diffusion were reviewed retrospectively. Diseases and conditions that were associated with a reversible lesion included epilepsy receiving AED (n=1), seizure from eclampsia receiving AED (n=1), mild infectious encephalitis (n=2), hypernatremia resulting in osmotic myelinolysis (n=1), and neoplasm (n=3) such as acute lymphocytic leukemia, spinal meningeal melanocytoma, and esophageal cancer. We evaluated MR imaging findings and clinical findings.


RESULTS
Seven patients had isolated SCC lesions; one patient with osmotic myelinolysis showed additional parenchymal lesions. The reversible SCC lesion shape was oval (n=6) or extended (n=2). The mean apparent diffusion coefficient value of the splenial lesion was 0.40+/-0.16 x 10-3 mm2/s, ranging from 0.22 to 0.64 x 10-3 mm2/s. In a patient with osmotic myelinolysis, additional white matter lesions, shown as restricted diffusion, were revealed as not reversible on follow-up MR imaging. Neurological courses and outcomes were good in seven patients with isolated SCC lesions, but poor in one with osmotic myelinolysis.


CONCLUSIONS
Reversible SCC lesion with restricted diffusion is apparent in a wide spectrum of diseases and conditions. Neurological courses and outcomes are good, particularly in patients with isolated SCC lesions. Knowledge of MR imaging findings and the associated spectrum of diseases and conditions might prevent unnecessary invasive examinations and treatments.
Maeda
M
M
Department of Radiology, Mie University School of Medicine, 174 Edobashi, Tsu, Mie 514-8507, Japan. mmaeda@clin.medic.mie-u.ac.jp
Tsukahara
H
H
Terada
H
H
Nakaji
S
S
Nakamura
H
H
Oba
H
H
Igarashi
O
O
Arasaki
K
K
Machida
T
T
Takeda
K
K
Takanashi
J I
JI
D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D003337:Corpus Callosum / Q000473:pathology*; D004660:Encephalitis / Q000150:complications / Q000382:microbiology / Q000473:pathology*; D004827:Epilepsy / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017590:Myelinolysis, Central Pontine / Q000150:complications / Q000473:pathology*; D009369:Neoplasms / Q000150:complications / Q000473:pathology*; D012189:Retrospective Studies
D000927:Anticonvulsants