Cytotoxic lesion of the corpus callosum involving splenium
Abstract
A 37-year-old African American woman with history of hypertension and tobacco abuse presented with slurred speech after waking up in the morning. Examination showed severe dysarthria without associated neurological deficits. Brain MRI showed restricted diffusion in the splenium without contrast enhancement (Figure 1). Investigations showed Legionella pneumophila associated pneumonia which was treated with levofloxacin. Her malignancy/autoimmune workup, ammonia level, CSF analysis, CT angiogram of head and neck, echocardiogram, and urine toxicology were unremarkable. Cytotoxic lesion of the corpus callosum (CLOCC) is associated with seizure, the usage as well as sudden cessation of antiepileptic drugs, drug therapy, malignancies, infections, metabolic disorders, sub-arachnoid hemorrhage, and other entities. It is thought to be secondary to cytokine-mediated glutamate cytotoxicity, and splenium is commonly affected region due to abundant glutamate and cytokine receptors. CLOCC is usually distinct with its non-enhancing restricted diffusion pattern involving splenium, symmetricity, small round or oval shape, and reversibility. Based on location, it is less likely to be an infarction, though it is often misdiagnosed as stroke.1
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