Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2012 Apr;15(2):151-7.
doi: 10.4103/0972-2327.95005.

Boomerang sign: Clinical significance of transient lesion in splenium of corpus callosum

Hardeep Singh Malhotra  1 , Ravindra Kumar Garg, Mukund R Vidhate, Pawan Kumar Sharma
Affiliations
Case Reports

Boomerang sign: Clinical significance of transient lesion in splenium of corpus callosum

Hardeep Singh Malhotra et al. Ann Indian Acad Neurol. 2012 Apr.

Abstract

Transient signal abnormality in the splenium of corpus callosum on magnetic resonance imaging (MRI) is occasionally encountered in clinical practice. It has been reported in various clinical conditions apart from patients with epilepsy. We describe 4 patients with different etiologies presenting with signal changes in the splenium of corpus callosum. They were diagnosed as having progressive myoclonic epilepsy (case 1), localization-related epilepsy (case 2), hemicrania continua (case 3), and postinfectious parkinsonism (case 4). While three patients had complete involvement of the splenium on diffusion-weighted image ("boomerang sign"), the patient having hemicrania continua showed semilunar involvement ("mini-boomerang") on T2-weighted and FLAIR image. All the cases had noncontiguous involvement of the splenium. We herein, discuss these cases with transient splenial involvement and stress that such patients do not need aggressive diagnostic and therapeutic interventions. An attempt has been made to review the literature regarding the pathophysiology, etiology, and outcome of such lesions.

Keywords: Boomerang sign; corpus callosum; diffusion-weighted imaging; epilepsy; hemicrania continua; magnetic resonance imaging; measles; splenium.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Magnetic resonance imaging and magnetic resonance angiography (Brain) of case 1, with refractory epilepsy, showing normal, axial, T1-weighted (a), T2-weighted (b) and fluid attenuated inversion recovery (c) images with increased signal intensity of the entire splenium of corpus callosum (“Boomerang sign”) on diffusion-weighted image (d); repeat diffusion-weighted image (e), done at 6 months, showing complete resolution of abnormal signals involving the splenium. Magnetic resonance angiogram (f) did not reveal any abnormality
Figure 2
Figure 2
Magnetic resonance imaging (Brain) of case 2, with localization related epilepsy, showing a right-sided well defined parafalcine extra-axial space occupying lesion, with perilesional edema, in T1-weighted axial (a), T2-weighted sagittal (b) and coronal (c) images. T2-weighted image (d), axial section, focussing on the corpus callosum appears normal while a uniform hyperintensity of the splenium of corpus callosum (“Boomerang sign”) on diffusion-weighted image (e) is evident. Follow up diffusion-weighted image (f), done at 1 week, depicts complete disappearance of altered signals in the splenium
Figure 3
Figure 3
Magnetic resonance imaging, magnetic resonance angiography and magnetic resonance venography (Brain) of case 3, with hemicrania continua, showing semilunar hyperintensity (“mini-boomerang”) on axial T2-weighted (a) and fluid attenuated inversion recovery (b) images with a focal hyperintensity on sagittal T2-weighted image (c); there was no evidence of restriction on diffusion-weighted image (d) and the apparant diffusion coefficient map (e) was normal. Lack of proper visualization of veins at the level of vein of Galen was evident on magnetic resonance venogram (f). Repeat T2-weighted image (g) and fluid attenuated inversion recovery image (h) at 3 months showing complete resolution of the abnormal signals in splenium. Magnetic resonance angiogram (i) did not reveal any abnormality
Figure 4
Figure 4
Magnetic resonance imaging (Brain) of case 4, with post-infectious parkinsonism, showing hyperintense signals in bilateral substantia nigra on axial T2-weighted image (a), more pronounced on left side; T1-weighted (b) and T2-weighted (c) images, axial section, focussing on the corpus callosum appear normal while a uniform hyperintensity of the splenium of corpus callosum (“Boomerang sign”) on diffusion-weighted image (d) is evident. Repeat diffusion-weighted image (e), done after 10 days, depicting reversibility of lesion involving the splenium of corpus callosum; the hyperintense signals involving the substantia nigra on axial T2-weighted image (f) decreased in size
See this image and copyright information in PMC

References

    1. Doherty MJ, Jayadev S, Konchada R, Hallam D, Watson NF. Clinical implications of splenium magnetic resonance imaging signal changes. Arch Neurol. 2005;62:433–7. - PubMed
    1. Conti M, Salis A, Urigo C, Canalis L, Frau S, Canalis GC. Transient focal lesion in the splenium of the corpus callosum: MR imaging with an attempt to clinical-physiopathological explanation and review of the literature. Radiol Med. 2007;112:921–35. - PubMed
    1. Tada H, Takanashi J, Barkovich AJ, Oba H, Maeda M, Tsukahara H, et al. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion. Neurology. 2004;63:1854–8. - PubMed
    1. Kato Z, Kozawa R, Hashimoto K, Kondo N. Transient lesion in the splenium of the corpus callosum in acute cerebellitis. J Child Neurol. 2003;18:291–2. - PubMed
    1. 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;70:459–63. - PMC - PubMed

Publication types