Cerebral Vasospasm Manifesting as a Transient Lesion of the Splenium of the Corpus Callosum Secondary to Pituitary Apoplexy

Jocelyn Y. Cheng and Tooba Fayyaz

Abstract

Background: Magnetic resonance imaging (MRI) abnormalities isolated to the splenium of the corpus callosum represent a unique radiologic phenomenon. The differential diagnosis includes toxic/metabolic dysfunction, demyelinating disease, seizures, trauma, tumor, infection and vasospasm. Though vasospasm may occur in multiple settings, splenial lesions associated with vasospasm secondary to hemorrhagic pituitary apoplexy have not been well described.
Methods: Case report, with review of clinical and radiologic data.
Results: A 50-year-old-right-handed-man presented with decreased visual acuity, right retro-orbital headache and right-sided ptosis over two weeks, followed by complete vision loss in the right eye two days prior to admission. Initial MRI brain revealed findings consistent with hemorrhagic pituitary apoplexy, as well as a non-enhancing lesion of the splenium, which demonstrated diffusion restriction on diffusion weighted imaging with apparent diffusion coefficient correlation, and which was hypointense on T1 and hyperintense on T2. MR spectroscopy excluded neoplasm and demyelinating disease. CTA of the head and neck followed by confirmatory digital subtraction angiography demonstrated narrowing of the parasellar arteries, consistent with vasospasm. The patient was treated with nimodopine and dexamethasone, and post-operative MRI after transnasal transphenoidal resection showed resolution of the splenial lesion.
Conclusion: Lesions isolated to the splenium may represent cerebral vasospasm. Early recognition is essential and should trigger further investigation, as cerebral vasospasm and pituitary apoplexy represent neurological emergencies in which prognosis can be favorable with early and appropriate management.

Published on: January 17, 2018
doi: 10.17756/jnpn.2018-018
Citation:  Cheng JY, Fayyaz T. 2018. Cerebral Vasospasm Manifesting as a Transient Lesion of the Splenium of the Corpus Callosum Secondary to Pituitary Apoplexy. J Neuroimaging Psychiatry Neurol 2(2): 36-42.

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