1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [5ae17401-2f5d-4231-a1aa-f0639d76cf0e] => Array
        (
            [runtime-id] => 5ae17401-2f5d-4231-a1aa-f0639d76cf0e
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [65d08a71-4dc9-40b5-a67a-d80a019d3788] => Array
                        (
                            [runtime-id] => 65d08a71-4dc9-40b5-a67a-d80a019d3788
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;b4ccbda82b06b2cc966de77fd046fee1923f4e2f
                )

        )

)
1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => FreeToRead
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [b4abfbea-95eb-4b37-a2d0-50f5df683bb8] => Array
        (
            [runtime-id] => b4abfbea-95eb-4b37-a2d0-50f5df683bb8
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => FreeToRead
            [privilege] => Array
                (
                    [eefd661b-fba4-4c76-9e22-2c7cf5ec2d23] => Array
                        (
                            [runtime-id] => eefd661b-fba4-4c76-9e22-2c7cf5ec2d23
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;b4ccbda82b06b2cc966de77fd046fee1923f4e2f
                )

        )

)
1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => FreeToRead
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [db13cda8-7021-4fc6-8db7-a4765e41eaf9] => Array
        (
            [runtime-id] => db13cda8-7021-4fc6-8db7-a4765e41eaf9
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => FreeToRead
            [privilege] => Array
                (
                    [fa36d0cf-6ee3-4faa-8aef-a97abd9fa553] => Array
                        (
                            [runtime-id] => fa36d0cf-6ee3-4faa-8aef-a97abd9fa553
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;b4ccbda82b06b2cc966de77fd046fee1923f4e2f
                )

        )

)
1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [5ae17401-2f5d-4231-a1aa-f0639d76cf0e] => Array
        (
            [runtime-id] => 5ae17401-2f5d-4231-a1aa-f0639d76cf0e
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [65d08a71-4dc9-40b5-a67a-d80a019d3788] => Array
                        (
                            [runtime-id] => 65d08a71-4dc9-40b5-a67a-d80a019d3788
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;b4ccbda82b06b2cc966de77fd046fee1923f4e2f
                )

        )

)
1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [5ae17401-2f5d-4231-a1aa-f0639d76cf0e] => Array
        (
            [runtime-id] => 5ae17401-2f5d-4231-a1aa-f0639d76cf0e
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [65d08a71-4dc9-40b5-a67a-d80a019d3788] => Array
                        (
                            [runtime-id] => 65d08a71-4dc9-40b5-a67a-d80a019d3788
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;b4ccbda82b06b2cc966de77fd046fee1923f4e2f
                )

        )

)
1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [5ae17401-2f5d-4231-a1aa-f0639d76cf0e] => Array
        (
            [runtime-id] => 5ae17401-2f5d-4231-a1aa-f0639d76cf0e
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [65d08a71-4dc9-40b5-a67a-d80a019d3788] => Array
                        (
                            [runtime-id] => 65d08a71-4dc9-40b5-a67a-d80a019d3788
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;b4ccbda82b06b2cc966de77fd046fee1923f4e2f
                )

        )

)
1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [5ae17401-2f5d-4231-a1aa-f0639d76cf0e] => Array
        (
            [runtime-id] => 5ae17401-2f5d-4231-a1aa-f0639d76cf0e
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => Controlled
            [privilege] => Array
                (
                    [65d08a71-4dc9-40b5-a67a-d80a019d3788] => Array
                        (
                            [runtime-id] => 65d08a71-4dc9-40b5-a67a-d80a019d3788
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;b4ccbda82b06b2cc966de77fd046fee1923f4e2f
                )

        )

)
1naresh2naresh
Array
(
    [urn:ac.highwire.org:guest:identity] => Array
        (
            [runtime-id] => urn:ac.highwire.org:guest:identity
            [type] => guest
            [service-id] => ajnr-ac.highwire.org
            [access-type] => FreeToRead
            [privilege] => Array
                (
                    [urn:ac.highwire.org:guest:privilege] => Array
                        (
                            [runtime-id] => urn:ac.highwire.org:guest:privilege
                            [type] => privilege-set
                            [privilege-set] => GUEST
                        )

                )

            [credentials] => Array
                (
                    [method] => guest
                )

        )

    [5624d060-58bc-4363-a633-2cd0200648e1] => Array
        (
            [runtime-id] => 5624d060-58bc-4363-a633-2cd0200648e1
            [type] => toll-free-key
            [service-id] => ajnr-ac.highwire.org
            [access-type] => FreeToRead
            [privilege] => Array
                (
                    [c67d9df9-60c3-4bea-b287-48f127e1a3df] => Array
                        (
                            [runtime-id] => c67d9df9-60c3-4bea-b287-48f127e1a3df
                            [type] => toll-free-key
                        )

                )

            [credentials] => Array
                (
                    [method] => toll-free-key
                    [value] => tf_ipsecsha;b4ccbda82b06b2cc966de77fd046fee1923f4e2f
                )

        )

)


  
    







































































    Infarction of the Corpus Callosum: A Manifestation of Giant Cell Arteritis | American Journal of Neuroradiology  
    



















    

































    
  
  




    
    

  

      


    

      

  
  
  

    

  

    

  

                
    

      

  

    

  
      
  
  

    


Advertisement



  



  


  
  



  



    

  


  


  


  
  
  
  
  
  

  	      



          


    
      

    
  
    
        
    

  

    
                        

  

                
    

      

	  

		
		

			

			  

  
      
  
  

    

  
  
      
LetterLetter

  
      

  
      
Infarction of the Corpus Callosum: A Manifestation of Giant Cell Arteritis
  
    	
J. Lempel, S. Bernstein and P. Kalina

  
    	
American Journal of Neuroradiology October 2011,  32 (9) E182-E183; DOI: https://doi.org/10.3174/ajnr.A2763 

  
  
  



  


  
  



			

		

	
	
 	
	  
  

		
		

			

			  

  
      
  
  

    
  


  
  



  
      
  
  

    

  

    

  
      
  
  

    
Cerebral vasculitis is a known cause of ischemic and hemorrhagic strokes and has been described as one of the rare but important causes of corpus callosum infarction. Biopsy-proved giant cell arteritis causing callosal infarction is an exceedingly rare finding because a tissue specimen is usually not obtained and conclusions are drawn on the basis of clinical and radiologic findings alone. We present a case of callosal infarction, which evolved and eventually affected large portions of both cerebral hemispheres. 
A 63-year-old woman presented to our hospital with left-sided numbness and neglect, cognitive changes, and apraxia. One month earlier, she was found to have a C-reactive protein level of 8.0 mg/dL (normal <0.5 mg/dL) and 75% stenosis in both femoral arteries. These results prompted a temporal artery biopsy, yielding a diagnosis of giant cell arteritis. On admission, head CT demonstrated low attenuation in the splenium of the corpus callosum (Fig 1). Considerations included infarction, tumor, demyelination, or infection. Subsequent CT angiography (CTA) revealed segmental narrowing and beading involving the petrous segment of both internal carotid arteries (Fig 2) and along the splenial or posterior pericallosal arteries within the posterior circulation. The condition of the patient continued to decline during the following week, culminating in a coma. An MR image obtained 12 days after the initial presentation revealed involvement of the entire corpus callosum, both cerebral hemispheres, and the right cerebellum with restricted diffusion indicating infarction secondary to intracranial vasculitis (Fig 3). In addition, hemorrhage was noted in the cortical gyri (Fig 4). 
Fig 1.
Fig 1. 

Noncontrast head CT scan demonstrates low attenuation in the splenium of the corpus callosum (arrow).
Fig 2.
Fig 2. 

Oblique sagittal reformatted maximum intensity projection image from a CTA image depicts beading and narrowing of the left internal carotid artery (arrow).
Fig 3.
Fig 3. 

Diffusion-weighted image shows hyperintensity in the corpus callosum and within both cerebral hemispheres.
Fig 4.
Fig 4. 

T2-weighted gradient recalled-echo image shows curvilinear areas of decreased signal intensity within the left parietal lobe, indicating susceptibility artifacts resulting from hemorrhage (arrows).
Lesions of the corpus callosum can present a diagnostic dilemma, both for the radiologist and the clinician. Clinically, they are associated with neuropsychiatric symptoms, mainly interhemispheric disconnection syndromes. Patients may experience gait disorders, apraxia, agraphia, and tactile anomia.1 While the corpus callosum is affected by varying disease processes, ischemia tends to spare this unique white matter structure. One accepted theory that explains relative callosal immunity to infarction relates to its rich blood supply delivered from the anterior and posterior circulations. In a study by Chrysikopoulos et al,2 the authors described the splenium as being most commonly involved in thromboembolic causes of callosal infarction, very likely due to the predilection for posterior cerebral artery versus anterior cerebral artery territory ischemia. In our patient, the lesion began in the splenium and progressed rostrally to involve the body and genu and eventually a large portion of both cerebral hemispheres. The global involvement in our case was secondary to diffuse vasculitis rather than more focal thromboembolic disease. 
Johnson et al3 described a case of biopsy-proved cerebral vasculitis that was seen as bilateral parieto-occipital “masses” that crossed the splenium of the corpus callosum. Greenan et al4 described a series of 7 clinically suspected cases of cerebral vasculitis in which only 1 was biopsy-proved arteritis, but that single case did not involve the corpus callosum. Other cases in that series did cause infarcts in the deep white matter, including the corpus callosum and capsular tracts, but their diagnosis of vasculitis was based on clinical and radiographic findings alone. We have thus presented an unusual case of corpus callosum infarction with a known causal entity of vasculitis. 
References
  1. 1.↵


    1. Giroud  M, 
    2. Dumas  R
    .
Clinical and topographical range of callosal infarction: a clinical and radiological correlation study. J Neurol Neurosurg Psychiatry 1995; 59: 238–42
    Abstract/FREE Full Text
  2. 2.↵


    1. Chrysikopoulos  H, 
    2. Andreou  J, 
    3. Roussakis  A, 
    4. et al
    .
Infarction of the corpus callosum: computed tomography and magnetic resonance imaging. Eur J Radiol 1997; 25: 2–8
    CrossRefPubMed
  3. 3.↵


    1. Johnson  M, 
    2. Maciunas  R, 
    3. Dutt  P, 
    4. et al
    .
Granulomatous angiitis masquerading as a mass lesion. Surg Neurol 1989; 31: 49–53
    CrossRefPubMed
  4. 4.↵


    1. Greenan  TJ, 
    2. Grossman  RI, 
    3. Goldberg  HI
    .
Cerebral vasculitis: MR imaging and angiographic correlation. Radiology 1992; 182: 65–72
    PubMed
  


  
  



  
      
  
  

    
  


  
  



  




  


  
  



  
      
  
  

    
  


  
  



  
      
  
  

     Back to top  


  
  



			

		

		
		

			

			  

  
        
In this issue

    
  
  

    
  


  
  



  
      
  
  

    

  

    

  
      
  
  

    


Advertisement



  



  


  
  



  



  


  
  



  
      
  
  

    

	  
  

		

          

            

  
      
  
  

     Print  


  
  



  
      
  
  

     Download PDF  


  
  



  
      
  
  

    
 Email Article
  


  
  



  
      
  
  

    
 Citation Tools
  


  
  



          

        

        
        

          

            



  
      
  
  

    

  

    

  
      
  
  

    

  
  
  
  
      
Infarction of the Corpus Callosum: A Manifestation of Giant Cell Arteritis
  
    	
J. Lempel, S. Bernstein, P. Kalina

  
    	
American Journal of Neuroradiology Oct 2011, 32 (9) E182-E183; DOI: 10.3174/ajnr.A2763 

  
  
  



  


  
  



  
      
  
  

    

  
    
  
  
    
  
  
    
  


  


  
  



  
      
  
  

    
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  


  
  



  



  


  
  



  
      
  
  

    
  


  
  



          

        

	
 	
	
	


  


  
  



  
      
  
  

    
              Purchase  


  
  



  
        
Jump to section

    
  
  

    
  


  
  



  
      
  
  

    
  


  
  



			

		

	
	
 	
	
	


    

  



  

                
    

      

  

    

  
      
  
  

    


Advertisement