[Case of consciousness disturbance following a fever with spreading lesion over the bilateral splenia of the corpus callosum on MRI].
We report a 66-year-old man with spreading lesion over the bilateral splenia of the corpus callosum shown on MRI. On admission, unknown fever and myoclonus-like involuntary movement in the left forefinger and middle finger were observed. There were no remarkably abnormal data in the serum, the cerebrospinal fluid and electroencephalogram. However, T2-weighted MRI revealed the high signal spreading over the bilateral splenia of the corpus callosum, while enhanced effects were not observed by Gd contrast on T1-weighted MRI. Diffusion and FLAIR MRI also showed the high signals limited to the same part of the splenia bilaterally as on T2-weighted MRI, discriminating it from other lacunar lesions and old cerebral infarctions. Neurological features, which were considered to be directly associated with the fresh lesion, were impairment of verbal and visual memories. Near the time the therapies including high-dose steroid were given, the consciousness of the patient worsened rapidly on a day-to-day basis and disseminated intravascular coagulation syndrome (DIC) also occurred. By administering low-molecule heparin, consciousness disturbance and involuntary movements recovered completely. Following the improved symptoms, FLAIR MRI showed a reduced level of the signal seven months after the onset. A demyelinating disease over the bilateral splenia of the corpus callosum should be considered as the final diagnosis. Follow-up of the changes in this case is expected to provide a more accurate diagnosis.
Nishimoto
Yoshinori
Y
Department of Neurology, Ashikaga Red Cross Hospital.
Isozumi
Kazuo
K
Ushioda
Ryuichi
R
Komatsumoto
Satoru
S
Fukuuchi
Yasuo
Y
D000368:Aged; D001284:Atrophy; D003141:Communicable Diseases / Q000150:complications; D003244:Consciousness Disorders / Q000209:etiology* / Q000628:therapy; D003337:Corpus Callosum / Q000473:pathology*; D004211:Disseminated Intravascular Coagulation / Q000209:etiology / Q000628:therapy; D004673:Encephalomyelitis, Acute Disseminated / Q000209:etiology* / Q000473:pathology* / Q000628:therapy; D005334:Fever / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009207:Myoclonus / Q000209:etiology / Q000628:therapy; D011379:Prognosis