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Case Reports
. 2021 Jun 18:2021:5573822.
doi: 10.1155/2021/5573822. eCollection 2021.

Vertigo and Cytotoxic Lesions of the Corpus Callosum: Report with Review of the Literature

John Rolshoven  1 , Katelyn Fellows  1 , Rolando Ania  1   2 , Burton J Tabaac  1   3
Affiliations
Case Reports

Vertigo and Cytotoxic Lesions of the Corpus Callosum: Report with Review of the Literature

John Rolshoven et al. Case Rep Neurol Med. .

Abstract

Background: The term cytotoxic lesions of the corpus callosum (CLOCCs) encompasses the entity reversible splenial lesion syndrome (RESLES). RESLES typically presents with altered levels of consciousness, seizures, and delirium and is distinguished radiographically by reversible focal lesions of the splenium of the corpus callosum. This disease pathology is associated with withdrawal of antiepileptic medications, infections, metabolic disturbance, or high-altitude cerebral edema.

Methods: We presented an otherwise healthy 72-year-old female that was consulted for an episode of isolated vertigo lasting four hours. Initial workup included CT head without contrast, CT angiogram head and neck, and MRI brain with and without contrast. The patient experienced recurrent episodes of vertigo at one and four months after initial presentation. An extensive workup at one month included a wide spectrum of laboratory tests and repeat imaging.

Results: Noncontrast CT of the head and CT angiogram of the head and neck were reassuring. MRI brain with and without contrast demonstrated hyperintensity in the splenium of the corpus callosum on FLAIR sequencing. A follow-up visit at one month revealed vitamin B12 deficiency and unchanged hyperintensity of the splenium of the corpus callosum. History and workup were negative for typical risk factors associated with RESLES.

Conclusion: An otherwise healthy patient who presented with an isolated episode of vertigo was discovered to demonstrate radiographic features consistent with RESLES but lacked the common risk factors and typical presentation of RESLES. This case expands the possible clinical presentation of RESLES and highlights the possible relationship between vitamin B12 deficiency and radiographic features of RESLES.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
MR brain with and without contrast on admission. (a) DWI, axial cut. (b) ADC axial cut. (c) FLAIR axial cut. (d) T2 axial cut. (e) FLAIR coronal cut. Imaging reveals hyperintensity in the splenium of the corpus callosum.
Figure 2
Figure 2
MR brain with and without contrast at one month follow up. (a) DWI, axial cut. (b) ADC axial cut. (c) FLAIR axial cut. (d) T2 axial cut. In comparison, the corpus callosum lesion is stable compared to prior imaging with the absence of novel interval lesions.
See this image and copyright information in PMC

References

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