Akademik Veri Yönetim Sistemi
15th Congress of the European Paediatric Neurology Society (EPNS), Praha, Çek Cumhuriyeti, 20 - 24 Haziran 2023, ss.543
Objective: The cytotoxic lesions of the corpus callosum (CLOCCs) was named also as mild encephalitis/encephalopathy with a
reversible splenial lesion (MERS), is characterized by transient cytotoxic ovoid lesions at the splenium of the corpus callosum in
patients without epilepsy or viral infections. Neurological manifestations include altered consciousness, seizures, behavioral
changes, and delirium. Various clinical conditions are associated with CLOCCs.
We aim to report three cases of CLOCCs with different etiologies.
Methods: .....
Results: Case 1
A 13-year-old girl was referred to our pediatric intensive care unit because of altered consciousness and fever. On the physical
examination, no abnormality was detected except for hyperpigmented spots in the folds of the hands and feet and on the gingiva.
Laboratory tests detected hyponatremia. Brain MRI showed diffusion restriction in the splenium of the corpus callosum. The serum
level of adrenocorticotropic hormone, which was checked for hyperpigmentation, was found to be very high. Based on these
findings, she was diagnosed with CLOCCs associated with primary adrenal insufficiency. Oral hydrocortisone therapy was
administered. She completely recovered.
Case 2
A previously healthy 17-year-old girl was admitted to our pediatric emergency outpatient clinic with a fever, vomiting, and
headache. Physical examination revealed signs of meningeal irritation. Brain MRI showed a cytotoxic ovoid lesion in the splenium
of the corpus callosum. Lumbar puncture was performed and no pathological finding was found except for mild protein elevation.
Based on these findings, she was diagnosed with CLOCCs associated with aseptic meningitis.
Case 3
A 14-year-old girl was admitted to our pediatric emergency outpatient clinic with a fever, altered consciousness, and syncope. The
systemic and neurological examination were normal. Brain MRI was compatible with CLOCCs. The level of troponin T was very high
and electrocardiography showed ST elevation. Echocardiography revealed effusion in the pericardium. She was diagnosed with
acute perimyocarditis, but no viral agent was found.
Conclusions: CLOCCs may present with acute encephalopathy and therefore may often be confused with meningoencephalitis
clinically. However, diffusion restriction in the splenium of the corpus callosum, indicative of transient cytotoxic edema, is typical.
CLOCCs should be kept in mind in patients who had acute neurological symptoms with typical MRI findings, even if the symptoms
were mild.