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Reversible focal splenial lesions

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Abstract

Reversible focal lesions in the splenium of the corpus callosum (SCC) have recently been reported.They are circumscribed and located in the median aspect of the SCC. On MRI, they are hyperintense on T2-W and iso-hypointense on T1-W sequences, with no contrast enhancement. On DWI, SCC lesions are hyperintense with low ADC values, reflecting restricted diffusion due to cytotoxic edema. The common element is the disappearance of imaging abnormalities with time, including normalization of DWI. Clinical improvement is often reported. The most established and frequent causes of reversible focal lesions of the SCC are viral encephalitis, antiepileptic drug toxicity/withdrawal and hypoglycemic encephalopathy. Many other causes have been reported, including traumatic axonal injury. The similar clinical and imaging features suggest a common mechanism induced by different pathological events leading to the same results. Edema and diffusion restriction in focal reversible lesions of the SCC have been attributed to excitotoxic mechanisms that can result from different mechanisms; no unifying relationship has been found to explain all the pathologies associated with SCC lesions. In our opinion, the similar imaging, clinical and prognostic aspects of these lesions depend on a high vulnerability of the SCC to excitotoxic edema and are less dependent on the underlying pathology. In this review, the relevant literature concerning reversible focal lesions in the SCC is analyzed and hypotheses about their pathogenesis are proposed.

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Authors and Affiliations

  1. Department of Radiology, S. Salvatore Hospital, University of L’Aquila, Via Natali - Coppito, 67100, L’Aquila, Italy

    Massimo Gallucci & Nicola Limbucci

  2. Department of Neuroradiology, Loreto Nuovo Hospital, Napoli, Italy

    Amalia Paonessa

  3. Neuroradiology, Department of Neurological Sciences, Federico II University, Napoli, Italy

    Ferdinando Caranci

Authors
  1. Massimo Gallucci
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  2. Nicola Limbucci
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  3. Amalia Paonessa
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  4. Ferdinando Caranci
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Correspondence to Massimo Gallucci.

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We declare that we have no conflict of interest.

This paper is one of a series of invited reviews.

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Gallucci, M., Limbucci, N., Paonessa, A. et al. Reversible focal splenial lesions. Neuroradiology 49, 541–544 (2007). https://doi.org/10.1007/s00234-007-0235-z

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  • DOI: https://doi.org/10.1007/s00234-007-0235-z

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