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Clinical implications of splenium magnetic resonance imaging signal changes
Michael J Doherty1, Sumie Jayadev, Nathaniel F Watson
1Department of Neurology, The University of Washington, Seattle, USA. michael.doherty@swedish.org
Background:
Magnetic resonance imaging (MRI) may show discrete splenium abnormalities; however, the implications of this radiologic finding are unclear.
Objective:
To describe causes, clinical presentations, and prognoses of midline splenium changes evident on MRI.
Design:
Retrospective case series.
Setting:
Teaching hospital.
Patients:
Medical records of 9 patients with MRI-noted splenium changes were studied; 60 additional published cases were accessed.
Interventions:
Sixty-nine cases were reviewed.
Main Outcome Measures:
Clinical and imaging findings, causes, and prognosis.
Results:
Confusion (35 patients), ataxia (25 patients), and recent seizure (23 patients) were common. Causes included alcohol use, infections, hypoglycemia, trauma, salt abnormalities, and seizure. Twenty-eight patients had complete resolution, 23 improved, and 1 died. Diffusion-weighted imaging showed splenium abnormalities the best. Eleven of 12 patients showed decrease in apparent diffusion coefficient. Most improved clinically, as did their subsequent MRI studies.
Conclusions:
Midline splenium changes are commonly seen on MRI diffusion-weighted imaging sequences. Multiple causes can result in splenium changes. Physicians should evaluate for glucose and electrolyte abnormalities, seizure risk, ongoing infectious or parainfectious process, and traumatic causes.