Splenium hyperintensity

Neuro Radio MeetDr. Mitusha Verma

Case 1

16 year Male patient with history of fall from train on 04.09.13,unconcious since then.

CT SCAN (outside)

MRI(14.09.13)

Axial FLAIR

Axial FLAIR

Axial FLAIR

Axial T2W

Axial Diffusion Axial Diffusion

Axial Diffusion

Axial GRE

Coronal FLAIR

Large , ill defined lesion hyperintense on Flair and T2W images in body and splenium. These areas show restricted diffusion. Foci of hemorrhage also seen

Similar lesions seen in Right superior frontal parenchyma, bilateral inferomedial temporal parenchyma,right middle cerebellar peduncle,left superior cerebellum,left pons,left crus mid-brain.

These findings are suggestive of Diffuse axonal injuries.

Small subdural hematoma over right parieto-occipital convexity.

A depressed fracture of the right frontal bone is seen.

CASE 2…

47 yr , Male admitted with – fever with chills since 2 days 1 episode of ? Convulsions Bleeding from mouth. Patient is a known chronic alcohalic

Investigations

10.09.13 – Dengue NS1Ag +ve 11.09.13 – Disoriented EEG- Excess of slow activity on both

sides. 12.09.13- Platelets- 23000 12.09.13- MRI

Axial Diffusion Axial T2W

MR scan reveals, a small area of restricted diffusion in splenium of corpus callosum.

This finding is not specific and has been described in postictal edema, diffuse axonal injury, infective causes like dengue and influenza.

Clinical correlation is recommended.

Discussion…

Clinical conditions associated with Transient Splenial Hyper intensity

Epilepsy

Infection

Demylination

Metabolic

VascularMiscellaneou

s

SeizuresAnti-Epileptic OverdoseAbrupt Drug WithdrawlEncephalitisSalmonellaMalariaRota Virus

Acute disseminates EncephalomylitisSLE.Cerebro vascular diseasePost cardiac arrestPre eclamsiaPosterior reversible encephalopathy syndromeHypertensive encephalopathyMigraine with aura

Vitamin B12 deficiencyDrug toxicityHigh altitudinal cerebral edemaTrauma- axonal injuryPost RadiationLymphomas

HypoglycemiaHypo/Hyper NaRenal Failure Marchiafava-Bignami disease

Refractory Epilepsy – Boomerang sign

Epilepsy with SOL – Boomerang sign

Migraine pain

T H A N K Y O U…