Cytotoxic Lesions beyond the Corpus Callosum Following Acute Meningoencephalitis and Mycoplasma Pneumoniae Infection: A Case Report and Literature Review

Cytotoxic Lesions of the Corpus Callosum (CLOCCs) in a Patient with Epstein-Barr Infection: A Case Report and Literature Review

Background: Cytotoxic lesions of the corpus callosum (CLOCCs) are a rare disorder of various etiologies referred to as transient lesions of the splenium of the corpus callosum, with a usually mild clinical course. Epstein-Barr virus (EBV) is one of the factors potentially responsible for triggering this abnormality. Results: The authors present the case of a 15-year-old girl, so far without any health burden, who suffered from severe CLOCCs with the etiology of EBV. The patient was admitted to hospital because of hepatosplenomegaly and hypertransaminasemia. Her condition rapidly deteriorated-she had seizures with respiratory failure, requiring treatment in the PICU. The first MRI (magnetic resonance imaging) scan showed changes in the hippocampus, and, in the early control, changes like those of CLOCCs; in follow-up studies (one and three months after the onset of respiratory failure), a gradual incomplete regression of the changes in the corpus callosum was seen. Her clinical condition improved quickly, with no seizures during the follow-up and no signs of focal CNS deficits. Cases of CLOCCs are reported as a secondary syndrome connected with many disease entities (e.g., toxic, infectious, and metabolic). The clinical presentation ranges from asymptomatic to severe cases demanding intensive treatment. The diagnosis is determined via an MRI examination. Conclusions: The general prognosis for CLOCCs is good, though the normalization of a brain MRI can take several months. As the only method of showing CLOCCs, MRI is the imaging gold standard. Still, clinical abnormalities often precede radiological changes, as was the case with the reported patient.

Reversible splenial lesion syndrome in patient with acute motor and sensory axonal neuropathy

Even though the classical clinical concept supports the clear difference between diseases affecting the central and peripheral nervous systems, this difference is becoming less rigid. Here, we report the case of a 50-year-old male patient who presented with acroparaesthesia, headache, and flaccid tetraparesis after febrile diarrhea. Nerve conduction studies indicated action potentials with low amplitudes, which are typical in acute motor and sensory axonal neuropathy. Magnetic resonance revealed a round lesion in the splenium consistent with a diagnosis of reversible splenial lesion syndrome. A polyclonal antiganglioside antibody response was detected. The patient was successfully treated with intravenous immunoglobulins. The coexistence of reversible splenial lesion syndrome and acute motor and sensory axonal neuropathy has not been described in the literature so far. We discuss our diagnostic dilemmas and the possible role of antiganglioside antibodies in the occurrence of simultaneous lesions of the central and peripheral nervous systems.