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Transient Edematous Lesions of the Splenium in Epileptic Patients

  • Giovanna Carrara (a1), Edoardo Ferlazzo (a1), Donatella Tampieri (a1), Frederick Andermann (a1) and Denis Melanson (a1)...

Abstract:

Background:

Transient focal lesions in the splenium of the corpus callosum (SCC) have been previously described in patients with epilepsy or without epilepsy but receiving antiepileptic drugs (AED).

Case reports:

Two epileptic patients were admitted to our long-term monitoring unit. Antiepileptic drugs were completely discontinued a few days later. One patient had no seizures. The other had three attacks, the last of which occurred two days before a brain magnetic resonance imaging (MRI) was performed. In both cases brain MRI showed a lesion in the SCC characterized by high signal on T2-weighted images and no enhancement after Gadolinium infusion. The patients were discharged with their pre-admission medications. A follow-up MRI five weeks later showed resolution of the SCC lesions.

Conclusions:

The pathogenesis of transient SCC lesions in epileptic patients is still unclear. In our patients, either the sudden AED withdrawal or the seizures activity may be presumed to be the cause, though an individual susceptibility must also be considered.

RÉSUMÉ: Introduction:

Des lésions focales transitoires dans le bourrelet du corps calleux (BCC) ont déjà été décrites chez des patients épileptiques ou des patients sans épilepsie qui recevaient des médicaments anti-épileptiques (MAÉ).

Étude de cas:

Les médicaments anti-épileptiques ont été cessés complètement après quelques jours d’observation chez deux patients épileptiques admis à notre unité de surveillance prolongée. Un patient n’a pas eu de crise. L’autre a eu trois crises, la dernière étant survenue deux jours avant l’IRM cérébral. Chez les deux patients, l’IRM cérébral a montré une lésion du BCC caractérisée par un signal intense sur les images pondérées T2 et aucun rehaussement après infusion de gadolinium. Les patients ont quitté l’hôpital avec la même médication qu’ils prenaient avant leur admission. L’IRM faite cinq semaines plus tard a montré une résolution des lésions du BCC.

Conclusions:

La pathogenèse des lésions transitoires du BCC chez les patients épileptiques demeure obscure. Chez nos patients, bien qu’une susceptibilité individuelle doive être envisagée, le retrait soudain des MAÉ ou l’activité critique pourrait être en cause.

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Copyright

Corresponding author

Department of Radiology, McGill University, Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, QC H3A 2B4, Canada.

References

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1. Chason, DP, Fleckenstein, JL, Ginsburg, ML, Mendelsohn, DB, Mathews, D. Transient splenial edema in epilepsy: MR imaging evaluation. Proceedings of the 34th Annual Meeting of the American Society of Neuroradiology: June 21-27, 1996; Seattle. Chicago: Old Smith Printers, 1996.
2. Kim, SS, Chang, K, Kim, ST, et al. Focal lesion in the splenium of the corpus callosum in epileptic patients: antiepileptic drug toxicity? AJNR Am J Neuroradiol 1999; 20: 125129.
3. Polster, T, Hoppe, M, Ebner, A. Transient lesion in the splenium of the corpus callosum: three further cases in epileptic patients and a pathophysiological hypothesis. J Neurol Neurosurg Psychiatry 2001; 70: 459463.
4. Gurtler, S, Ebner, A, Woermann, FG. Transient lesion in the splenium of the corpus callosum in epilepsy is associated with rapid antiepileptic drug withdrawal. Epilepsia 2004; 45 (Suppl 3): S63.
5. Maeda, M, Shiroyama, T, Tsukahara, H, et al. Transient splenial lesion of the corpus callosum associated with antiepileptic drugs: evaluation by diffusion-weighted MR imaging. Eur Radiol 2003; 13: 19021906.
6. Mirsattari, SM, Lee, DH, Jones, MW, Blume, WT. Transient lesion in the splenium of the corpus callosum in an epileptic patient. Neurology 2003; 10; 60: 18381841.

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Transient Edematous Lesions of the Splenium in Epileptic Patients

  • Giovanna Carrara (a1), Edoardo Ferlazzo (a1), Donatella Tampieri (a1), Frederick Andermann (a1) and Denis Melanson (a1)...

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