Abscess in the Splenium of the Corpus Callosum Treated with Direct Drainage via an Occipital Interhemispheric Approach
Author(s)
Yasushi Motoyama1*,
Hisashi Kawai1,
Yohei Kogeichi1,
Pritam Gurung2,
Young-Soo Park1,
Hiroyuki Nakase1
Affiliation(s)
1 Department of Neurosurgery, Nara Medical University, Kashihara, Japan. 2 Ohnishi Neurological Center, Akashi, Japan.
1 Department of Neurosurgery, Nara Medical University, Kashihara, Japan. 2 Ohnishi Neurological Center, Akashi, Japan.
ABSTRACT
Lesions in the corpus callosum typically represent malignant tumors such as glioblastoma or lymphoma, because of its compact structure comprising tightly packed white-matter tracts. Brain abscess is rarely seen in the corpus callosum. To the best of our knowledge, solitary bacterial abscess confined to the splenium of the corpus callosum has not been reported previously. We report the case of a 72-year-old woman with rapidly progressing disturbance of consciousness following 1 week of antibiotic treatment for bacterial meningitis. Magnetic resonance imaging demonstrated a ring-enhancing round mass located in the splenium of the corpus callosum on gadolinium-enhanced T1-weighted imaging, also showing a bright signal on diffusion-weighted imaging. The patient underwent occipital craniotomy and direct drainage of the lesion in the splenium through the interhemispheric fissure and achieved complete recovery. Brain abscess should be considered among the differential diagnoses for lesions in the splenium of the corpus callosum. An occipital interhemispheric approach to the splenium might be an important option in cases of brain abscess.
Lesions in the corpus callosum typically represent malignant tumors such as glioblastoma or lymphoma, because of its compact structure comprising tightly packed white-matter tracts. Brain abscess is rarely seen in the corpus callosum. To the best of our knowledge, solitary bacterial abscess confined to the splenium of the corpus callosum has not been reported previously. We report the case of a 72-year-old woman with rapidly progressing disturbance of consciousness following 1 week of antibiotic treatment for bacterial meningitis. Magnetic resonance imaging demonstrated a ring-enhancing round mass located in the splenium of the corpus callosum on gadolinium-enhanced T1-weighted imaging, also showing a bright signal on diffusion-weighted imaging. The patient underwent occipital craniotomy and direct drainage of the lesion in the splenium through the interhemispheric fissure and achieved complete recovery. Brain abscess should be considered among the differential diagnoses for lesions in the splenium of the corpus callosum. An occipital interhemispheric approach to the splenium might be an important option in cases of brain abscess.
Cite this paper
Motoyama, Y. , Kawai, H. , Kogeichi, Y. , Gurung, P. , Park, Y. and Nakase, H. (2015) Abscess in the Splenium of the Corpus Callosum Treated with Direct Drainage via an Occipital Interhemispheric Approach. Open Journal of Modern Neurosurgery, 5, 34-40. doi: 10.4236/ojmn.2015.51006.
Motoyama, Y. , Kawai, H. , Kogeichi, Y. , Gurung, P. , Park, Y. and Nakase, H. (2015) Abscess in the Splenium of the Corpus Callosum Treated with Direct Drainage via an Occipital Interhemispheric Approach. Open Journal of Modern Neurosurgery, 5, 34-40. doi: 10.4236/ojmn.2015.51006.
References
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http://dx.doi.org/10.1161/01.STR.0000155733.65215.c2 [2] Gurtler, S., Ebner, A., Tuxhorn, I., Ollech, I., Pohlmann-Eden, B. and Woermann, F.G. (2005) Transient Lesion in the Splenium of the Corpus Callosum and Antiepileptic Drug Withdrawal. Neurology, 65, 1032-1036.
http://dx.doi.org/10.1212/01.wnl.0000179301.96652.27 [3] Kim, S.S., Chang, K.H., Kim, S.T., Suh, D.C., Cheon, J.E., Jeong, S.W., et al. (1999) Focal Lesion in the Splenium of the Corpus Callosum in Epileptic Patients: Antiepileptic Drug Toxicity? American Journal of Neuroradiology, 20, 125-129. [4] Loh, Y., Watson, W.D., Verma, A. and Krapiva, P. (2005) Restricted Diffusion of the Splenium in Acute Wernicke’s Encephalopathy. Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging, 15, 373-375.
http://dx.doi.org/10.1177/1051228405279037 [5] Maeda, M., Tsukahara, H., Terada, H., Nakaji, S., Nakamura, H., Oba, H., et al. (2006) Reversible Splenial Lesion with Restricted Diffusion in a Wide Spectrum of Diseases and Conditions. Journal of Neuroradiology, 33, 229-236.
http://dx.doi.org/10.1016/S0150-9861(06)77268-6 [6] Fath-Ordoubadi, F., Lane, R.J. and Richards, P.G. (1997) Histological Surprise: Callosal Tuberculoma Presenting as Malignant Glioma. Journal of Neurology, Neurosurgery, and Psychiatry, 63, 98-99.
http://dx.doi.org/10.1136/jnnp.63.1.98 [7] Lee, H.J., Williams, R., Kalnin, A. and Wolansky, L. (1996) Toxoplasmosis of the Corpus Callosum: Another Butterfly. American Journal of Roentgenology, 166, 1280-1281.
http://dx.doi.org/10.2214/ajr.166.6.8633432 [8] Cox, J., Murtagh, F.R., Wilfong, A. and Brenner, J. (1992) Cerebral Aspergillosis: MR Imaging and Histopathologic Correlation. American Journal of Neuroradiology, 13, 1489-1492. [9] Barlas, O., Sencer, A., Erkan, K., Eraksoy, H., Sencer, S. and Bayindir, C. (1999) Stereotactic Surgery in the Management of Brain Abscess. Surgical Neurology, 52, 404-410.
http://dx.doi.org/10.1016/S0090-3019(99)00118-4 [10] Chang, Y.T., Lu, C.H., Chuang, M.J., Huang, C.R., Chuang, Y.C., Tsai, N.W., et al. (2010) Supratentorial Deep-Seated Bacterial Brain Abscess in Adults: Clinical Characteristics and Therapeutic Outcomes. Acta Neurologica Taiwanica, 19, 178-183. [11] Fuentes, S., Bouillot, P., Regis, J., Lena, G. and Choux, M. (2001) Management of Brain Stem Abscess. British Journal of Neurosurgery, 15, 57-62.
http://dx.doi.org/10.1080/026886901300004120 [12] Moody, D.M., Bell, M.A. and Challa, V.R. (1988) The Corpus Callosum, a Unique White-Matter Tract: Anatomic Features That May Explain Sparing in Binswanger Disease and Resistance to Flow of Fluid Masses. American Journal of Neuroradiology, 9, 1051-1059. [13] Rees, J.H., Smirniotopoulos, J.G., Jones, R.V. and Wong, K. (1996) Glioblastoma Multiforme: Radiologic-Pathologic Correlation. Radiographics, 16, 1413-1438. [14] Erdag, N., Bhorade, R.M., Alberico, R.A., Yousuf, N. and Patel, M.R. (2001) Primary Lymphoma of the Central Nervous System: Typical and Atypical CT and MR Imaging Appearances. American Journal of Roentgenology, 176, 1319-1326.
http://dx.doi.org/10.2214/ajr.176.5.1761319 [15] Demaerel, P., Van de Gaer, P., Wilms, G. and Baert, A.L. (1996) Interhemispheric Lipoma with Variable Callosal Dysgenesis: Relationship between Embryology, Morphology, and Symptomatology. European Radiology, 6, 904-909.
http://dx.doi.org/10.1007/BF00240701 [16] Reinarz, S.J., Coffman, C.E., Smoker, W.R. and Godersky, J.C. (1988) MR Imaging of the Corpus Callosum: Normal and Pathologic Findings and Correlation with CT. American Journal of Roentgenology, 151, 791-798.
http://dx.doi.org/10.2214/ajr.151.4.791 [17] DeLone, D.R., Goldstein, R.A., Petermann, G., Salamat, M.S., Miles, J.M., Knechtle, S.J., et al. (1999) Disseminated Aspergillosis Involving the Brain: Distribution and Imaging Characteristics. American Journal of Neuroradiology, 20, 1597-1604. [18] Winslow, H., Mickey, B. and Frohman, E.M. (2006) Sympathomimetic-Induced Kaleidoscopic Visual Illusion Associated with a Reversible Splenium Lesion. Archives of Neurology, 63, 135-137.
http://dx.doi.org/10.1001/archneur.63.1.135 [19] Ogura, H., Takaoka, M., Kishi, M., Kimoto, M., Shimazu, T., Yoshioka, T., et al. (1998) Reversible MR Findings of Hemolytic Uremic Syndrome with Mild Encephalopathy. American Journal of Neuroradiology, 19, 1144-1145. [20] Ho, M.L., Moonis, G., Ginat, D.T. and Eisenberg, R.L. (2013) Lesions of the Corpus Callosum. American Journal of Roentgenology, 200, W1-W16.
http://dx.doi.org/10.2214/AJR.11.8080 [21] Oster, J., Doherty, C., Grant, P.E., Simon, M. and Cole, A.J. (2003) Diffusion-Weighted Imaging Abnormalities in the Splenium after Seizures. Epilepsia, 44, 852-854.
http://dx.doi.org/10.1046/j.1528-1157.2003.40902.x [22] Kimura, E., Okamoto, S., Uchida, Y., Hirahara, T., Ikeda, T., Hirano, T., et al. (2008) A Reversible Lesion of the Corpus Callosum Splenium with Adult Influenza-Associated Encephalitis/Encephalopathy: A Case Report. Journal of Medical Case Reports, 2, 220.
http://dx.doi.org/10.1186/1752-1947-2-220 [23] Jang, Y.Y. and Lee, K.H. (2010) Transient Splenial Lesion of the Corpus Callosum in a Case of Benign Convulsion Associated with Rotaviral Gastroenteritis. Korean Journal of Pediatrics, 53, 859-862.
http://dx.doi.org/10.3345/kjp.2010.53.9.859PMid:21189973 [24] Matsuoka, T., Yodoshi, T., Sugai, M., Hiyane, M., Matsuoka, T., Akeda, H., et al. (2013) A Case of Mild Encephalopathy with a Reversible Splenial Lesion Associated with G5P[6]Rotavirus Infection. Case Reports in Pediatrics, 2013, Article ID: 197163.
http://dx.doi.org/10.1155/2013/197163 [25] Takanashi, J., Barkovich, A.J., Yamaguchi, K. and Kohno, Y. (2004) Influenza-Associated Encephalitis/Encephalopathy with a Reversible Lesion in the Splenium of the Corpus Callosum: A Case Report and Literature Review. American Journal of Neuroradiology, 25, 798-802. [26] Conti, M., Salis, A., Urigo, C., Canalis, L., Frau, S. and Canalis, G.C. (2007) Transient Focal Lesion in the Splenium of the Corpus Callosum: MR Imaging with an Attempt to Clinical-Physiopathological Explanation and Review of the Literature. La Radiologia Medica, 112, 921-935.
http://dx.doi.org/10.1007/s11547-007-0197-9 [27] Tada, H., Takanashi, J., Barkovich, A.J., Oba, H., Maeda, M., Tsukahara, H., et al. (2004) Clinically Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion. Neurology, 63, 1854-1858.
http://dx.doi.org/10.1212/01.WNL.0000144274.12174.CB
[1] Bottcher, J., Kunze, A., Kurrat, C., Schmidt, P., Hagemann, G., Witte, O.W., et al. (2005) Localized Reversible Reduction of Apparent Diffusion Coefficient in Transient Hypoglycemia-Induced Hemiparesis. Stroke, 36, e20-e22.
http://dx.doi.org/10.1161/01.STR.0000155733.65215.c2 [2] Gurtler, S., Ebner, A., Tuxhorn, I., Ollech, I., Pohlmann-Eden, B. and Woermann, F.G. (2005) Transient Lesion in the Splenium of the Corpus Callosum and Antiepileptic Drug Withdrawal. Neurology, 65, 1032-1036.
http://dx.doi.org/10.1212/01.wnl.0000179301.96652.27 [3] Kim, S.S., Chang, K.H., Kim, S.T., Suh, D.C., Cheon, J.E., Jeong, S.W., et al. (1999) Focal Lesion in the Splenium of the Corpus Callosum in Epileptic Patients: Antiepileptic Drug Toxicity? American Journal of Neuroradiology, 20, 125-129. [4] Loh, Y., Watson, W.D., Verma, A. and Krapiva, P. (2005) Restricted Diffusion of the Splenium in Acute Wernicke’s Encephalopathy. Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging, 15, 373-375.
http://dx.doi.org/10.1177/1051228405279037 [5] Maeda, M., Tsukahara, H., Terada, H., Nakaji, S., Nakamura, H., Oba, H., et al. (2006) Reversible Splenial Lesion with Restricted Diffusion in a Wide Spectrum of Diseases and Conditions. Journal of Neuroradiology, 33, 229-236.
http://dx.doi.org/10.1016/S0150-9861(06)77268-6 [6] Fath-Ordoubadi, F., Lane, R.J. and Richards, P.G. (1997) Histological Surprise: Callosal Tuberculoma Presenting as Malignant Glioma. Journal of Neurology, Neurosurgery, and Psychiatry, 63, 98-99.
http://dx.doi.org/10.1136/jnnp.63.1.98 [7] Lee, H.J., Williams, R., Kalnin, A. and Wolansky, L. (1996) Toxoplasmosis of the Corpus Callosum: Another Butterfly. American Journal of Roentgenology, 166, 1280-1281.
http://dx.doi.org/10.2214/ajr.166.6.8633432 [8] Cox, J., Murtagh, F.R., Wilfong, A. and Brenner, J. (1992) Cerebral Aspergillosis: MR Imaging and Histopathologic Correlation. American Journal of Neuroradiology, 13, 1489-1492. [9] Barlas, O., Sencer, A., Erkan, K., Eraksoy, H., Sencer, S. and Bayindir, C. (1999) Stereotactic Surgery in the Management of Brain Abscess. Surgical Neurology, 52, 404-410.
http://dx.doi.org/10.1016/S0090-3019(99)00118-4 [10] Chang, Y.T., Lu, C.H., Chuang, M.J., Huang, C.R., Chuang, Y.C., Tsai, N.W., et al. (2010) Supratentorial Deep-Seated Bacterial Brain Abscess in Adults: Clinical Characteristics and Therapeutic Outcomes. Acta Neurologica Taiwanica, 19, 178-183. [11] Fuentes, S., Bouillot, P., Regis, J., Lena, G. and Choux, M. (2001) Management of Brain Stem Abscess. British Journal of Neurosurgery, 15, 57-62.
http://dx.doi.org/10.1080/026886901300004120 [12] Moody, D.M., Bell, M.A. and Challa, V.R. (1988) The Corpus Callosum, a Unique White-Matter Tract: Anatomic Features That May Explain Sparing in Binswanger Disease and Resistance to Flow of Fluid Masses. American Journal of Neuroradiology, 9, 1051-1059. [13] Rees, J.H., Smirniotopoulos, J.G., Jones, R.V. and Wong, K. (1996) Glioblastoma Multiforme: Radiologic-Pathologic Correlation. Radiographics, 16, 1413-1438. [14] Erdag, N., Bhorade, R.M., Alberico, R.A., Yousuf, N. and Patel, M.R. (2001) Primary Lymphoma of the Central Nervous System: Typical and Atypical CT and MR Imaging Appearances. American Journal of Roentgenology, 176, 1319-1326.
http://dx.doi.org/10.2214/ajr.176.5.1761319 [15] Demaerel, P., Van de Gaer, P., Wilms, G. and Baert, A.L. (1996) Interhemispheric Lipoma with Variable Callosal Dysgenesis: Relationship between Embryology, Morphology, and Symptomatology. European Radiology, 6, 904-909.
http://dx.doi.org/10.1007/BF00240701 [16] Reinarz, S.J., Coffman, C.E., Smoker, W.R. and Godersky, J.C. (1988) MR Imaging of the Corpus Callosum: Normal and Pathologic Findings and Correlation with CT. American Journal of Roentgenology, 151, 791-798.
http://dx.doi.org/10.2214/ajr.151.4.791 [17] DeLone, D.R., Goldstein, R.A., Petermann, G., Salamat, M.S., Miles, J.M., Knechtle, S.J., et al. (1999) Disseminated Aspergillosis Involving the Brain: Distribution and Imaging Characteristics. American Journal of Neuroradiology, 20, 1597-1604. [18] Winslow, H., Mickey, B. and Frohman, E.M. (2006) Sympathomimetic-Induced Kaleidoscopic Visual Illusion Associated with a Reversible Splenium Lesion. Archives of Neurology, 63, 135-137.
http://dx.doi.org/10.1001/archneur.63.1.135 [19] Ogura, H., Takaoka, M., Kishi, M., Kimoto, M., Shimazu, T., Yoshioka, T., et al. (1998) Reversible MR Findings of Hemolytic Uremic Syndrome with Mild Encephalopathy. American Journal of Neuroradiology, 19, 1144-1145. [20] Ho, M.L., Moonis, G., Ginat, D.T. and Eisenberg, R.L. (2013) Lesions of the Corpus Callosum. American Journal of Roentgenology, 200, W1-W16.
http://dx.doi.org/10.2214/AJR.11.8080 [21] Oster, J., Doherty, C., Grant, P.E., Simon, M. and Cole, A.J. (2003) Diffusion-Weighted Imaging Abnormalities in the Splenium after Seizures. Epilepsia, 44, 852-854.
http://dx.doi.org/10.1046/j.1528-1157.2003.40902.x [22] Kimura, E., Okamoto, S., Uchida, Y., Hirahara, T., Ikeda, T., Hirano, T., et al. (2008) A Reversible Lesion of the Corpus Callosum Splenium with Adult Influenza-Associated Encephalitis/Encephalopathy: A Case Report. Journal of Medical Case Reports, 2, 220.
http://dx.doi.org/10.1186/1752-1947-2-220 [23] Jang, Y.Y. and Lee, K.H. (2010) Transient Splenial Lesion of the Corpus Callosum in a Case of Benign Convulsion Associated with Rotaviral Gastroenteritis. Korean Journal of Pediatrics, 53, 859-862.
http://dx.doi.org/10.3345/kjp.2010.53.9.859PMid:21189973 [24] Matsuoka, T., Yodoshi, T., Sugai, M., Hiyane, M., Matsuoka, T., Akeda, H., et al. (2013) A Case of Mild Encephalopathy with a Reversible Splenial Lesion Associated with G5P[6]Rotavirus Infection. Case Reports in Pediatrics, 2013, Article ID: 197163.
http://dx.doi.org/10.1155/2013/197163 [25] Takanashi, J., Barkovich, A.J., Yamaguchi, K. and Kohno, Y. (2004) Influenza-Associated Encephalitis/Encephalopathy with a Reversible Lesion in the Splenium of the Corpus Callosum: A Case Report and Literature Review. American Journal of Neuroradiology, 25, 798-802. [26] Conti, M., Salis, A., Urigo, C., Canalis, L., Frau, S. and Canalis, G.C. (2007) Transient Focal Lesion in the Splenium of the Corpus Callosum: MR Imaging with an Attempt to Clinical-Physiopathological Explanation and Review of the Literature. La Radiologia Medica, 112, 921-935.
http://dx.doi.org/10.1007/s11547-007-0197-9 [27] Tada, H., Takanashi, J., Barkovich, A.J., Oba, H., Maeda, M., Tsukahara, H., et al. (2004) Clinically Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion. Neurology, 63, 1854-1858.
http://dx.doi.org/10.1212/01.WNL.0000144274.12174.CB