Corpus Callosum Holes
Karen L. Salzman, MD
DIFFERENTIAL DIAGNOSIS
Common
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Multiple Sclerosis
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Diffuse Axonal Injury (DAI)
Less Common
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Post-Surgical
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ADEM
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Obstructive Hydrocephalus
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Lacunar Infarction
Rare but Important
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Enlarged Perivascular Spaces
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Marchiafava-Bignami Disease
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Susac Syndrome
ESSENTIAL INFORMATION
Helpful Clues for Common Diagnoses
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Multiple Sclerosis
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Callososeptal interface T2 hyperintensities
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“Burned out” chronic lesions have T1 hypointense center, very slight hyperintense rim (lesion within lesion)
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Diffuse Axonal Injury (DAI)
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Punctate hemorrhages at gray-white interfaces & corpus callosum (CC) typical
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“Blooming” on T2*, GRE, SWI common
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May result in focal encephalomalacia
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Helpful Clues for Less Common Diagnoses
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Post-Surgical
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Small CC “holes” common after shunt
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Defects may result from transcallosal surgery (e.g., for colloid cyst)
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ADEM
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Both subcortical white matter (WM), deep gray nuclei often involved
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May mimic multiple sclerosis
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Obstructive Hydrocephalus
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Dorsal, middle layers may show T1 hypointense & T2 hyperintense signal
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May be related to CC compression against falx during acute ventricular obstruction
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Lacunar Infarction
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Uncommon; rich blood supply to CC
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Focal ischemia with surrounding gliosis
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Supplied by anterior communicating artery, pericallosal artery, & posterior pericallosal artery
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Helpful Clues for Rare Diagnoses
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Enlarged Perivascular Spaces
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Follow CSF on all sequences
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When CC involved, adjacent brain often involved
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Marchiafava-Bignami Disease
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Rare complication of chronic alcoholism; CC demyelination & necrosis
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T2 hyperintense CC (middle layers) virtually pathognomonic
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