1
|
Stamm B, Lineback CM, Tang M, Jia DT, Chrenka E, Sorond F, Sabayan B. Diffusion-Restricted Lesions of the Splenium: Clinical Presentation, Radiographic Patterns, and Patient Outcomes. Neurol Clin Pract 2023; 13:e200196. [PMID: 37840827 PMCID: PMC10573033 DOI: 10.1212/cpj.0000000000200196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/12/2023] [Indexed: 10/17/2023]
Abstract
Background and Objectives Diffusion-restricted (DR) lesions of the splenium are encountered in a wide variety of pathologies, and their significance is often unclear. We sought to report the spectrum of clinical presentations, neuroimaging patterns, and the predictors of radiographic and clinical outcomes from DR splenial lesions. Methods This was a single-center, retrospective cohort study from January 1, 2009, to August 1, 2020. A consecutive sample of 3,490 individuals who underwent brain MRI with reported corpus callosum lesions during the study period were evaluated for DR lesions in the corpus callosum. DR lesions were defined as increased signal intensity on diffusion-weighted imaging sequences with decreased signal intensity on apparent diffusion coefficient. Patients with prior neurosurgical procedures, hemorrhage-associated DR, anoxic brain injury, and chronic or previously known or characterized disease processes in the corpus callosum were excluded. Clinical and radiologic outcomes were ascertained, including readmissions within 1 year, in-hospital mortality rates, and resolution of DR at first follow-up imaging. Outcomes were defined a priori. Results Two hundred patients met criteria for inclusion. The average age was 57 years (standard deviation 19 years). Near half of the patients were women (47%). Encephalopathy (55%), focal weakness (46.5%), and cortical signs (44%) were the most common presenting clinical features. Thirty-five cases (17.5%) had features consistent with cytotoxic lesions of the corpus callosum (CLOCCs). Vascular causes were most frequent (61%), followed by malignancy-related (15%) and trauma (8%). In-hospital mortality occurred in 8.5% of cases, 46.5% were readmitted to the hospital within 1 year, and 49.1% of patients had resolution of the splenial DR at the next scan. Backward stepwise regression models showed that mass effect was negatively associated with splenial DR resolution (odds ratio [OR]: 0.12, confidence interval [CI] 0.03-0.46, p = 0.002). Encephalopathy was significantly associated with in-hospital mortality (OR: 4.50, CI 1.48-17.95, p = 0.007). Patients with a CLOCC had less frequent readmissions at 1-year compared with patients without a CLOCC, p = 0.015. Discussion Vascular DR lesions of the splenium were more common than CLOCCs and other etiologies in this cohort. While splenial DR lesions can present a clinical challenge, their associated clinical and radiographic characteristics may predict outcome and guide prognosis.
Collapse
Affiliation(s)
- Brian Stamm
- University of Michigan (B. Stamm, CML), Ann Arbor; Northwestern University (B. Stamm, MT, DTJ, FS), Chicago, IL; Neurology (B. Sabayan), HealthPartners Institute (EC), Minneapolis, MN
| | - Christina M Lineback
- University of Michigan (B. Stamm, CML), Ann Arbor; Northwestern University (B. Stamm, MT, DTJ, FS), Chicago, IL; Neurology (B. Sabayan), HealthPartners Institute (EC), Minneapolis, MN
| | - Mengxuan Tang
- University of Michigan (B. Stamm, CML), Ann Arbor; Northwestern University (B. Stamm, MT, DTJ, FS), Chicago, IL; Neurology (B. Sabayan), HealthPartners Institute (EC), Minneapolis, MN
| | - Dan Tong Jia
- University of Michigan (B. Stamm, CML), Ann Arbor; Northwestern University (B. Stamm, MT, DTJ, FS), Chicago, IL; Neurology (B. Sabayan), HealthPartners Institute (EC), Minneapolis, MN
| | - Ella Chrenka
- University of Michigan (B. Stamm, CML), Ann Arbor; Northwestern University (B. Stamm, MT, DTJ, FS), Chicago, IL; Neurology (B. Sabayan), HealthPartners Institute (EC), Minneapolis, MN
| | - Farzaneh Sorond
- University of Michigan (B. Stamm, CML), Ann Arbor; Northwestern University (B. Stamm, MT, DTJ, FS), Chicago, IL; Neurology (B. Sabayan), HealthPartners Institute (EC), Minneapolis, MN
| | - Behnam Sabayan
- University of Michigan (B. Stamm, CML), Ann Arbor; Northwestern University (B. Stamm, MT, DTJ, FS), Chicago, IL; Neurology (B. Sabayan), HealthPartners Institute (EC), Minneapolis, MN
| |
Collapse
|
2
|
Yum KS, Shin DI. Transient splenial lesions of the corpus callosum and infectious diseases. Acute Crit Care 2022; 37:269-275. [PMID: 35977887 PMCID: PMC9475166 DOI: 10.4266/acc.2022.00864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022] Open
Abstract
Transient splenial lesion of the corpus callosum can be observed in various diseases such as cancer, drug use, metabolic disorders, and cerebrovascular disorders, as well as in patients with infectious diseases. During the coronavirus disease 2019 (COVID-19) pandemic, there were increasing reports of these lesions being detected on brain imaging tests performed in patients with neurological symptoms. On brain magnetic resonance imaging, findings suggestive of cytotoxic edema are observed in the splenium; these are known to disappear with improvement of clinical symptoms. Cytokinopathy caused by infection increases the permeability of the blood–brain barrier and activates the glial cells of the brain to induce cytotoxic edema. Most patients have a good prognosis. The causes, mechanism, diagnosis, treatment and prognosis of transient splenial lesions of the corpus callosum will be summarized in this review.
Collapse
|