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Case: CLOCC from Seizure Medication on MRI

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Patient from the floor on the neurology service

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who presented with a change in mental status.

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AMS, that's what you'll see on the request slip.

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That's as much as you get.

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Hopefully, you have EMR to be able to look at the

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patient's history a little bit more than that.

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As we scroll these T2-weighted and FLAIR images, I have

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to say that I don't see very much at all on this patient.

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No mass, no hydrocephalus.

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Ventricle size normal, no significant abnormality.

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However, let's take a look at the

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patient's diffusion-weighted imaging.

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Here's the diffusion-weighted scan, and what you see

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is a focal area of signal intensity abnormality in

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the splenium of the corpus callosum, and that is it.

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In retrospect, that corresponds to this

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very subtle high-signal intensity area

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in the patient's splenium of the corpus callosum on

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the FLAIR scan, although I must admit that on the,

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just on the FLAIR scan, I wouldn't have made that call.

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You want to make sure that this is indeed

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cytotoxic edema rather than vasogenic edema.

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So, you call down, of course, the ADC map,

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which is over here, and wow, it is black. Right?

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So, this is a cytotoxic lesion of the corpus callosum.

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In this case, you look into the electronic

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medical record, and you find that they started

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carbamazepine on this patient for seizure prophylaxis.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

MRI

Emergency

Drug related

Brain

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