Mehmet BARBUROĞLU, Rana Günöz CÖMERT, Heydar HUSEYNOV, Seçkin ÇOBANOĞLU, Çağrı ULUKAN, Osman KİPOĞLU, Orhan COŞKUN, Mine SEZGİN, Metin UYSALOL

KORPUS KALLOZUMUN SİTOTOKSİK LEZYONLARI: MANYETİK REZONANS GÖRÜNTÜLEME BULGULARI VE ETİYOLOJİK FAKTÖRLER

Amaç: Korpus kallozumun sitotoksik lezyonları (KKSL) genellikle korpus kallozum spleniumunda diffüzyon kısıtlılığı olarak saptanan farklı birçok klinik durum ile ilişkilendirilmiş nadir bir radyolojik bulgudur. Çalışmamızın amacı kliniğimizde manyetik rezonans görüntülemesinde (MRG) KKSL saptanan olguların radyolojik ve klinik bulgularını incelemek ve literatür eşliğinde değerlendirmektir. Gereç ve Yöntem: Ocak 2017 – Mart 2021 tarihleri arasında erişkin ve pediatri acil servislerine ensefalopati ve epilepsi benzeri nörolojik şikayetler ile başvuran, diffüzyon veya kraniyal MRG çekilmiş yaklaşık 850 hastanın görüntülemeleri retrospektif olarak tarandı. KKSL saptanan 29 hasta (20 erkek, 9 kadın) çalışmaya dahil edilerek radyolojik ve klinik bulguları değerlendirildi. Bulgular: Yaş ortalaması 26,4 yıl (5-72 yıl) olarak hesaplandı. Hastalarda dizartri, bilinç bulanıklığı, ataksi, senkop, epileptik nöbet, baş ağrısı gibi nörolojik semptomlar mevcuttu. Hastalardan 20 (%68,9) tanesinde çeşitli enfeksiyonların merkezi sinir sisteminine direkt veya indirekt etkisi ile lezyonların geliştiği görüldü. Üç hastada diyabetik, bir hastada üremiye bağlı metabolik dekompansasyon saptanmıştır. Diğer 5 hastada; subaraknoid hemoraji, astım atağı, travma, yüksek doz lityum - levetirasetam alımı ve antiepileptik ilaç çekilmesi gibi etyolojik faktörlere bağlı geliştiği değerlendirildi. Yirmi hastada MR kontrolü bulunmaktaydı. 16 (%80) hastada bulgular 6 gün ile 8 ay arasında normale dönmüştür (Median 30, Ortalama 53,8 gün). Diğer 4 hastadan birinde parsiyel regresyon olduğu, 3 hastada sekel gliozis ile iyileştiği izlendi. Sonuç: Kallozal sitotoksik lezyonlar altta yatan geniş bir klinik spektrum ile ilişkili nonspesifik kranial MRG bulgularıdır. Genellikle geri dönüşümlüdür. Radyolojik olarak tanınmaları, altta yatan klinik etiyolojinin saptanması, iskemik inme ve tümör benzeri yanlış tanılardan kaçınılması, uygun hasta yönetimi için önemlidir.

Anahtar Kelimeler:

Sitotoksik kallozal lezyonlar, reversibl splenial lezyon, korpus kallozum

CYTOTOXIC LESIONS OF THE CORPUS CALLOSUM: MAGNETIC RESONANCE IMAGING FINDINGS AND ETIOLOGIC FACTORS

Objective: Cytotoxic lesions of the corpus callosum (CLOCCs) are usually detected as a diffusion restriction in the splenium of the corpus callosum. They are rare secondary radiological findings associated with various clinical entities. The aim of this study is to evaluate the magnetic resonance imaging (MRI) findings and underlying clinical factors of cases with CLOCCs. Materials and Methods: The MRI images of 850 patients who were admitted to the emergency services between January 2017 and March 2021 with encephalopathy and epilepsy-like neurological complaints were scanned retrospectively. Twenty nine patients (20 men, 9 women) with CLOCCs were included in the study. Their radiological and clinical findings were evaluated. Results: The mean age was calculated as 26.4 years (5-72 years). The patients had neurological symptoms such as dysarthria, confusion, ataxia, syncope, epileptic seizure, and headache. Lesions were developed secondary to various infections in 20 (68.9%) patients. Diabetic decompensation was found in three patients and uremic decompensation in one patient. In the remaining patients, subarachnoid hemorrhage, asthma attack, trauma, high-dose lithium-levetiracetam intake and anti-epileptic drug withdrawal were responsible. Twenty patients had MRI control. In 16 (80%) patients, MRI findings returned to normal between 6 days and 8 months (median 30, Mean 53.8 days). One of the other 4 patients had partial regression, and 3 patients recovered with sequelae gliosis. Conclusion: CLOCCs are nonspecific MRI findings associated with a broad underlying clinical spectrum. They are usually reversible. Determination of the underlying clinical etiology, avoidance of an ischemic stroke and tumor-like misdiagnoses are important for appropriate patient management.

Keywords:

Cytotoxic callosal lesions reversible splenial lesion, splenium, corpus callosum,

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1. Filippi CG, Cauley KA. Lesions of the corpus callosum and other commissural fibers: diffusion tensor studies. Semin Ultrasound CT MR 2014;35(5):445-58. [CrossRef] google scholar
2 . Lee SK, Kim DI, Kim J, Kim DJ, Kim HD, Kim DS, et al. Diffusion-tensor MR imaging and fiber tractography: a new method of describing aberrant fiber connections in developmental CNS anomalies. Radiographics 2005;25(1):53-68. [CrossRef] google scholar
3. Chason DP, Fleckenstein JL, Ginsburg ML, Mendelsohn DB, Mathews D. Transient splenial edema in epilepsy: MR imaging evaluation. Presented at the annual meeting ofthe American Society of Neuroradiology, June 21-27, Seattle, WA, 1996. google scholar
4. Kim SS, Chang KH, Kim ST, Suh DC, Cheon JE, Jeong SW, et al. Focal lesion in the splenium of the corpus callosum in epileptic patients: antiepileptic drug toxicity ? AJNR Am J Neuroradiol 1999;20(1):125-9. google scholar
5. Maeda M,Tsukahara H, Terada H, Nakaji S, Nakamura H, Oba H, et al. Reversible splenial lesion with restricted diffusion in a wide spectrum of diseases and conditions. Journal of neuroradiology 2006;33(4): 229-36. [CrossRef] google scholar
6. Singh P, Gogoi D, Vyas S, Khandelwal N. Transient splenial lesion: Further experience with two cases. Indian J Radiol Imaging 2010;20(4):254-7. [CrossRef] google scholar
7. Garcia-Monco JC, Cortina IE, Ferreira E, Martınez A, Ruiz L, Cabrera A, et al. Reversible Splenial Lesion Syndrome (RESLES): What’s in a Name? J Neuroimaging 2011;21(2):e1-14. [CrossRef] google scholar
8. Park JY, Lee IH, Song CJ, Hwang HY. Transient Splenial Lesions in the Splenium of Corpus Callosum in Seven Patients: MR Findings and Clinical Correlations. J Korean Soc Magn Reson Med 2013;17(1):1-7. [CrossRef] google scholar
9. Cohen-Gadol AA, Britton JW, Jack CR Jr, Friedman JA, Marsh WR. Transient postictal magnetic resonance imaging abnormality of the corpus callosum in a patient with epilepsy. J Neurosurg 2002;97(3):714-7. [CrossRef] google scholar
10. Oztoprak I, Engin A, Gümüs C, Egilmez H, Oztoprak B. Transient splenial lesions of the corpus callosum in different stages of evolution. Clin Radiol 2007;62(9):907-13. [CrossRef] google scholar
11. Güven H, Delibaş S, Comoğlu SS. Transient lesion in the splenium of the corpus callosum due to carbamazepine. Turk Neurosurg 2008;18(3):264-70. google scholar
12. Starkey J , Kobayashi N, Numaguchi Y, Moritani T. Cytotoxic Lesions of the Corpus Callosum That Show Restricted Diffusion: Mechanisms, Causes, and Manifestations. RadioGraphics 2017;37(2):562-76. [CrossRef] google scholar
13. Takanashi J, Barkovich AJ, Shiihara T, Tada H, Kawatani M, Tsukahara H, et al. Widening spectrum of a reversible splenial lesion with transiently reduced diffusion. AJNR Am J Neuroradiol 2006;27(4):836-8. google scholar