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We read with interest the report of patients with splenium of corpus callosum (SCC) lesions, most being reversible with transiently reduced apparent diffusion coefficient (ADC) values.1 We previously described 15 patients with clinically mild encephalitis/encephalopathy with identical reversible SCC lesions,2 and we postulated that intramyelinic edema due to separation of myelin layers was a possible mechanism for the transiently decreased ADC. We recently saw a neonate with an identical SCC lesion, suggesting that the mechanism underlying the lesion might not be related to myelination.
Diffusion-weighted images of a neonate with mild asphyxia at age 12 days revealed a lesion of high signal intensity in the central portion of the SCC with a decreased ADC value (Figure, A). Magnetic resonance imaging also demonstrated T1 shortening in the bilateral ventral thalamus and deep sulci of insular regions, which likely resulted from perinatal asphyxia, without any abnormal signal on the diffusion-weighted images. He gradually improved and was discharged at age 18 days with oral administration of phenobarbital. Follow-up magnetic resonance imaging at 6 months showed a normal shape of the corpus callosum, no splenial or insural lesions, and almost normal myelination, including SCC (Figure, B). At age 1 year, he had mild hypotonia without paralysis, mild psychomotor retardation (at an almost 10-month-old level), and no epileptic seizures.
A, Diffusion-weighted image of neonate with mild asphyxia at age 12 days. B, Follow-up diffusion-weighted image at 6 months of age.
Magnetic resonance imaging in this neonatal patient revealed an identical reversible SCC lesion with a transiently reduced ADC value. Pathologically, no myelination of SCC occurs before age 2 months. Therefore, intramyelinic edema cannot occur in the neonatal period and is unlikely to be a possible mechanism underlying the reversible SCC lesion in the present patient. Another possible explanation is inflammatory infiltrate. A diffusion-weighted image study of multiple sclerosis revealed decreased ADC values in some lesions from multiple sclerosis, and it was postulated that the influx of inflammatory cells and macromolecules might have caused the decreased ADC values. A decreased ADC value in SCC may be a result of inflammation, and the ADC may return to normal if the cause resolves quickly.
Correspondence: Dr Takanashi, Department of Pediatrics, Kameda Medical Center, 929 Higashi-cho, Kamogawa-shi, Chiba 296-8602, Japan (jtaka@kameda.jp).
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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