Corpus callosum infarcts with atypical clinical and radiologic presentations

Abstract

Infarcts of the corpus callosum have not been well documented in the radiologic literature. We present five cases that were unusual in either their clinical or radiologic presentation or both. Biopsies were performed in three of the five cases, and in time, all lesions evolved in a pattern consistent with infarct. Recognition of the varied clinical and radiologic presentation of infarcts of the corpus callosum will obviate the need for biopsy in most patients.

fig 1.

Case 1. Axial postcontrast CT image (A) and coronal postcontrast T1-weighted image (B) (480/20/1 [TR/TE/excitations]) show a non-enhancing lesion within both sides of the genu (curved arrow) of the corpus callosum with mass effect on the frontal horns. Axial T2-weighted image (C) (2500/105/1) shows corresponding high signal intensity within the genu of the corpus callosum (curved arrow), crossing the midline. An old infarct is noted within the right posterior border zone and scattered foci of T2 signal abnormality are seen in the left frontal and parietal regions. A biopsy of the lesion was obtained, confirming an infarct

fig 2.

Case 2. Postcontrast axial T1-weighted image (A) (500/20/1) shows subtle enhancement with surrounding hypointensity within the genu of the corpus callosum (arrows). FLAIR images (B, C) (8900/140/1) show abnormal increased signal within both sides of the genu and body of the corpus callosum. Axial FLAIR images (D, E) (8900/140/1) from follow-up MR imaging performed 3 weeks later showed almost complete resolution of the abnormal signal within the corpus callosum

fig 3.

Case 3. Sagittal precontrast T1-weighted image (A) (400/12/2) shows a hypointense ovoid mass (arrow) within the body of the corpus callosum, depressing the roof of the lateral ventricle. After administration of contrast material (B) (400/12/2), it enhances homogeneously. A small infarct (white arrow) is noted within the right thalamus on the axial T2-weighted image (C) (2560/90/1). Subsequent biopsy confirmed an infarct

fig 4.

Case 4. Sagittal non-contrast T1- (A) (400/10/1) and coronal T2-weighted (B) (2500/105/1) images show abnormal signal within the body of the corpus callosum and adjacent white matter (arrow) on the left side. Sagittal (C) (400/8/2) and coronal (D) (450/20/1) postcontrast T1-weighted images from a subsequent MR examination show abnormal enhancement (arrow) within the corpus callosum and adjacent white matter