Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of suspected multiple sclerosis with transcallosal lesions involving the upper surface of the corpus callosum

Toshihiko Shirafuji, M.D.1)2), Yasushi Oya, M.D.1), Harumasa Nakamura, M.D.1)3), Katsuhisa Ogata, M.D.1)4), Masafumi Ogawa, M.D.1) and Mitsuru Kawai, M.D.1)4)

1)Department of Neurology, Graduate School of Medicine, Kobe University
2)Department of Neurology, Musashi Hospital, National Center of Neurology and Psychiatry
3)Pharmaceuticals and Medical Devices Agency
4)Department of Neurology, Higashi-Saitama National Hospital

A 26-year-old woman noticed gradually progressive, right lower leg weakness over a 1.5-month period. Neurological examination revealed right hemiparesis with slightly increased deep tendon reflexes, Babinski's sign on the right side, loss of position sense in the right leg, and slight loss of superficial sensation in the right toes. MR FLAIR images showed a high intensity area measuring 5×2×3 cm in the left frontal lobe, extending to the outer surface of the body of the corpus callosum and the adjacent right cingulate gyrus. Gadolinium enhancement was seen along the cortex and the outer surface of the body of the corpus callosum. CSF findings showed no pleocytosis, a protein content of 32 mg/dl, a sugar level of 85 mg/dl, and an IgG index of 0.46.
The biopsy specimen obtained from the superior frontal gyrus showed perivascular cuffing of T-lymphocytes and some B-lymphocytes, as well as multiple small foci of demyelination. Starting on the second day of admission, the patient was treated with methylprednisolone pulse therapy (1,000 mg/day for 3 days); she was then switched to oral prednisolone (20 mg/day). Thereafter, the patient had two clinical relapses: one was due to a lesion in the dorsal part of the medulla oblongata associated with a disturbance of deep sensation in both hands, and the other was due to a lesion involving the right internal capsule, the globus pallidus, and the caudate nucleus associated with left facial nerve palsy. Visual evoked potentials suggested a demyelinating lesion in the right optic nerve. We suspected a diagnosis of multiple sclerosis based on the presence of more than two clinical episodes of neurological deficits with identifiable lesions on MRI.
Multiple sclerosis should be considered in the differential diagnosis of lesions located in the outer part of the corpus callosum and transcallosal bilateral hemispheres on MRI, even though inner callosal lesions are common in multiple sclerosis.
Full Text of this Article in Japanese PDF (1291K)

(CLINICA NEUROL, 48: 321－327, 2008)
key words: multiple sclerosis, corpus callosum, MRI, demyelination, subcortical gadolinium-enhanced lesions

(Received: 1-Mar-07)