International Journal of Clinical & Medical Images

Clinical Image

A 33 years old woman, with no medical history record, was admitted in the ER for fever and consciousness disorder evolving for a few days [1-3]. The patient had received her second dose of Sars-CoV-2 vaccine 15 days before. Clinical exam revealed a GCS (Glasgow Coma Scale) of 13/15, a slight fever (38.5°C), and tetraparesia. Blood tests only showed a high CRP (C-reactive protein) level at 160 mg/L, with no sign of infection. Sars-CoV-2 PCR (Polymerase chain reaction) was negative. Cytotoxic lesions of the corpus callosum are caused by cytotoxic edema due to cytokines storm after infection, trauma, and sub-arachnoid hemorrhage, drug therapy such as seizure drugs, vaccination, metabolic disorders and malignancy.

Clinical symptoms aren’t specific

• Consciousness disorders, seizures, hallucinations, nuchal rigidity etc.

Brain MRI is specific, showing an oval shaped well-defined lesion of the splenium of the corpus callosum (Yellow arrow), with restriction in diffusion (B), non-enhanced with contrast (C), which is characteristic (Figure 1).

Differential diagnosis

• Ischemic stroke of the anterior cerebral artery, however, this diagnosis is rare because of redundant blood supply.

• Acute disseminated encephalomyelitis that is more aggressive with asymmetric lesions. Treatment

• Treatment remains on steroids and immunoglobulin administration.

Keywords: Corpus; Callosum; Lesion; MRI

Declaration of Interests

The authors declare that they have no competing interests.

References

[1] Youn T, Yang H (2021) Cytotoxic lesion of the corpus callosum (CLOCCs) after SARS-CoV-2 mRNA vaccination. J Korean Med Sci 36: 1-2.

[2] Gaur P, Dixon L, Jones B, Lyall H, Jan W (2020) COVID-19-associated cytotoxic lesions of the corpus callosum. Am J Neuroradiol 41: 1905-1907. [3] Rasmussen C, Niculescu I, Patel S, Krishnan A (2020) COVID-19 and involvement of the corpus callosum: Potential effect of the cytokine storm. Am J Neuroradiol 41: 1625-1628.