Case 29 - CLOCC from Seizure Medication MRI

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

Indication: Antiphospholipid lipid syndrome. Protein C deficiency. Slurred speech, difficulty walking, arm and hand numbness and weakness.

Technique: Outside MRI MRA images of the brain and neck and cervical spine from Baltimore Washington Medical Center dated May 30, 2017 were submitted for second opinion interpretation.

Findings:

Brain:

The signal intensity of the brain parenchyma is normal. Gradient echo scans show no evidence of hemorrhage. The diffusion-weighted imaging shows restricted diffusion in the central aspect of the splenium of the corpus callosum. No other areas of restricted diffusion are identified.

There are no post gadolinium enhanced images.

Cervical spine:

The alignment of the vertebral bodies is normal. The signal intensity of the cervical spinal cord is normal. Axial scans through the cervical spine are unremarkable other than a tiny central disc herniation at C5-6 with associated mild foraminal narrowing from uncovertebral joint degenerative changes. There are no neck masses seen. Both vertebral arteries are patent.

MRA of the brain

Both vertebral arteries, the basilar artery and both carotid arteries are patent. The right anterior inferior cerebellar artery is not seen. There are no areas of vascular stenosis or aneurysm formation.

MR venographic images without contrast show nonvisualization of the entirety of the left transverse sinus. The superior sagittal sinus, straight sinus, and right transverse sinus are normal in appearance. There is an arachnoid granulation seen on T2-weighted scans which is indenting the left transverse sinus.


IMPRESSION:

Focal area of restricted diffusion in the splenium of the corpus callosum. This can be seen in patients with seizures or epileptic drug changes as well as after trauma, demyelination, or even ischemia. Nutritional factors may also lead to focal demyelination in the splenium. Clinical correlation is required. The
remainder of the brain is normal. The cervical spine is unremarkable. The intracranial vasculature shows normal variation nonvisualization of the   right anterior-inferior cerebellar
artery.