Corpus Callosum Lesion Without Mass Effect



Corpus Callosum Lesion Without Mass Effect


Karen L. Salzman, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Multiple Sclerosis


  • Diffuse Axonal Injury (DAI)


Less Common



  • PML


  • ADEM


  • Periventricular Leukomalacia


Rare but Important



  • Enlarged Perivascular Spaces


  • Vasculitis


  • Lyme Disease


  • Susac Syndrome


  • X-Linked Adrenoleukodystrophy


  • Metachromatic Leukodystrophy (MLD)


ESSENTIAL INFORMATION


Helpful Clues for Common Diagnoses



  • Multiple Sclerosis



    • Multiple perpendicular callososeptal T2 hyperintensities characteristic


    • Corpus callosum (CC) almost always involved, subcallosal striations early


  • Diffuse Axonal Injury (DAI)



    • Punctate hemorrhages at corticomedullary junction & CC typical


    • CC involvement in 20%; 75% involve splenium/undersurface of posterior body


Helpful Clues for Less Common Diagnoses



  • PML



    • Bilateral, asymmetric involvement typical


    • Large multifocal subcortical white matter (WM) lesions without mass effect


  • ADEM



    • 10-14 days after viral illness/vaccination


    • Involves subcortical WM, deep gray nuclei


    • May mimic multiple sclerosis


  • Periventricular Leukomalacia



    • Small CC typical, ± T2 hyperintensity


    • Peritrigonal WM loss & “wavy” ventricular margins


Helpful Clues for Rare Diagnoses

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Corpus Callosum Lesion Without Mass Effect

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