Abstracts

Rationale: There are several case reports of reversible splenial lesions (RSL) in the corpus callosum in various conditions including epilepsy and antiepileptics withdrawal. However, there is no report of sudden onset stroke like symptoms caused by RSLs. Here we report two cases of reversible splenial lesions in non epileptic patients who presented with acute onset stroke like symptoms and vision loss. Methods: We reveiwed the charts and imaging of both the patients and followed them after 2 months. We also did literature search and found 7 case reports on reversible splenial lesions. Results: First patient was a 19-year old female with a history of bipolar disorder who presented with sudden onset alexia without agraphia that lasted for 10-hours. Her brain MRI showed a non-enhancing central splenial lesion with restricted diffusion. Second patient was a 26 year old right-handed female with a history of migraines and recent gastric bypass surgery who presented with multiple episodes of transient bilateral vision loss over a 5-hour period with each episode lasting for 1-2 minutes. Her MRI also showed a similar lesion in spenium. In both the patients the splenial carpus callosal (SCC) lesions were central, ovoid, non-enhancing and revealed restricted diffusion. Computerised tomographic angiography of the intracranial vessels, and CSF and serum analysis including testing for demyelinating and infections processes, levels of B12, copper and zinc were normal. These lesions disappeared at follow-up MRI exams after 2 months of initial presentation. Conclusions: Since our patients did not have epilepsy, it is strongly suggested that the AEDs, rather than epilepsy is one of the contributing factors in RSL. With the variety of AED's in the market and the continuous introduction of newer formulations, incidence of such rare entities may begin to increase. Practicing neurologists must be aware of such benign, transient clinical radiological lesions in order to improve patient care and be mindful of health care costs.