Cytotoxic lesion of the corpus callosum in pediatrics: A case report

Abstract

Cytotoxic lesions of the corpus callosum are considered a clinical-radiological syndrome that generates transitory damage to the corpus callosum; especially in the splenium, with a multicausal origin such as drugs, malignant neoplasms, infections, subarachnoid hemorrhage, metabolic disorders, and traumas. The clinical presentation varies in severity. Some patients have complete recovery in a few days, while others present a more serious clinical, requiring admission to pediatric intensive care. We present a case of a pediatric patient with cytotoxic lesions of the corpus callosum (CLOCCs) confirmed by brain magnetic resonance imaging (MRI). The patient was admitted due to gastrointestinal symptoms, progressing to altered consciousness, postural instability, dysarthria, and paroxysmal events. A literature search of all reported cases of compromises of CLOCCs was carried out to identify the different terms used to describe this syndrome and consolidated a report of utility in the clinic of this pathology.

Keywords: Benign seizure; Cytotoxic lesions of the corpus callosum; Magnetic resonance imaging; Viral illness.

Fig 1

cMRI Intraaxial focal lesion in the splenium of the CC with diffusion restriction attributable to cytotoxic edema.

Fig 2

MRI complete resolution of the diffusion restriction focuses on the splenium of the CC, without residual lesions.

Fig 3

Causes distribution. Viral infections include adenovirus infection (n = 3), COVID-19 (n = 7), Cytomegalovirus (n = 2), Echovirus 6 (n = 3), Epstein Barr (n = 1), Herpesvirus type 6 (n = 3), Influenza A (n = 7), Influenza B (n = 2), Parainfluenza 1-3 (n = 1), and Rotavirus (n = 13). Bacterial infections include Campylobacter infection (n = 1), Enterococcus Faecalis (n = 1), Escherichia Coli (n = 1), Listeria Monocytogenes (n = 1), Mycoplasma (n = 4), Neisseria Meningitidis (n = 1), Salmonella (n = 1), and Streptococcus Pneumoniae (n = 2).

Fig. 4

Symptoms more frequent. Altered consciousness (n = 38), fever (n = 30), seizures (n = 24), vomiting (n = 23), motor impairment (n = 15), headache (n = 13), cough (n = 12), hallucinations (n = 12), dysarthria (n = 10), diarrhea (n = 8), abdominal pain (n = 7) and drowsiness (n = 7).

Fig. 5

Timeline of designations of CC cytotoxic lesion. However, it is noteworthy that when searching for cases reported in the literature, the term CLOCCs is not frequently used in the publications, with only 4 case reports in which the term is included, 3 of them from 2020 and 1 from 2021 (Fig. 6). This may mean that the different scientific associations have not yet unified the term, which may lead to confusion when identifying, diagnosing, and treating any patient with this condition.

Fig. 6

Year of diagnosis and terminology. 2020-2022: Reversible splenial injury (MERS) (n = 35), cytotoxic injury of the corpus callosum (ClOCCs) (n = 4), reversible splenial injury syndrome (RESLES) (n = 27). 2017-2019: Reversible splenial injury (MERS) (n = 5), cytotoxic injury of the corpus callosum (ClOCCs) (n=0), reversible splenial injury syndrome (RESLES) (n = 5). 2014-2016: Reversible splenial injury (MERS) (n=30), cytotoxic injury of the corpus callosum (ClOCCs) (n = 0), reversible splenial injury syndrome (RESLES) (n = 5). 2011-2013: reversible splenial injury (MERS) (n = 7), cytotoxic injury of the corpus callosum (ClOCCs) (n = 0), reversible splenial injury syndrome (RESLES) (n = 1). 2008-2010: reversible splenial injury (MERS) (n = 3), cytotoxic injury of the corpus callosum (ClOCCs) (n = 0), reversible splenial injury syndrome (RESLES) (n = 0). 2005-2007: reversible splenial injury (MERS) (n = 0), cytotoxic injury of the corpus callosum (ClOCCs) (n = 0), reversible splenial injury syndrome (RESLES) (n = 1).