Case report: Re-evaluating reversibility of cytotoxic lesions of the corpus callosum.

Frontiers in neuroimaging Pub Date : 2025-02-17 eCollection Date: 2025-01-01 DOI:10.3389/fnimg.2025.1436931
Victoria Vold, Stein-Helge Hansen Tingvoll, Mona K Beyer, Kaja Nordengen
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Abstract

Cytotoxic lesions of the corpus callosum (CLOCC) are a clinicoradiological diagnosis, characterized by transient neurological symptoms and magnetic resonance imaging (MRI) changes in the splenium of the corpus callosum (SCC), which in most cases is completely reversible. However, the long-term pathophysiological trajectory and ultimate neurological outcomes of CLOCC remain largely unknown due to limited long-term follow-up data. We report an 11-year follow-up of a postpartum female with CLOCC, initially presenting with transient focal neurological symptoms and extensive diffusion-restricted white matter involvement including the SCC and surrounding area with diffusion restriction and low apparent diffusion coefficient values, indicative of cytotoxic edema. The edema regressed in days; over the years, she remained asymptomatic despite persistent white matter changes on MRI in the centrum semiovale. This case challenges the view of CLOCC as completely reversible and raises questions regarding the significance of lasting white matter changes. The enduring absence of neurological symptoms and stable radiological profile throughout the decade underscores the singular nature of CLOCC and the lasting, though isolated, impact on white matter. This report contributes a crucial perspective, suggesting that CLOCC may involve just an isolated episode without recurrent events or progressive neurological decline. By offering the first longitudinal analysis of a CLOCC episode with an extended follow-up of over a decade, our case enhances current knowledge about the long-term neurological and radiological landscape of this condition. It suggests a reevaluation of the conceptual understanding of CLOCC as an entirely reversible, non-relapsing disorder, highlighting the need for further research into its long-term impacts on cerebral white matter integrity.

病例报告:重新评估胼胝体细胞毒性病变的可逆性。
胼胝体细胞毒性病变(CLOCC)是一种临床放射学诊断,其特征是短暂的神经系统症状和胼胝体(SCC)脾脏的磁共振成像(MRI)改变,在大多数情况下是完全可逆的。然而,由于长期随访数据有限,CLOCC的长期病理生理轨迹和最终神经学结局在很大程度上仍然未知。我们报告了一名产后CLOCC女性患者的11年随访,最初表现为短暂的局灶性神经症状和广泛的弥漫性白质受累,包括SCC和周围区域,弥漫性受限和低表观弥漫性系数值,表明细胞毒性水肿。水肿逐渐消退;多年来,尽管MRI显示半骨正中持续出现白质改变,但患者仍无症状。该病例挑战了CLOCC是完全可逆的观点,并提出了关于持久白质变化的重要性的问题。在整个十年中,神经系统症状的持续消失和稳定的放射学特征强调了CLOCC的独特性和对白质的持久影响,尽管是孤立的。该报告提供了一个至关重要的观点,表明CLOCC可能只是一个孤立的发作,没有复发事件或进行性神经功能衰退。通过首次对CLOCC发作进行纵向分析,并进行了超过十年的随访,本病例增强了当前对该疾病长期神经学和放射学的认识。该研究建议重新评估CLOCC作为一种完全可逆、非复发性疾病的概念理解,并强调需要进一步研究其对脑白质完整性的长期影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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