Transient Splenial Lesion in New Onset Severe Persistent Daily Headache: A Clinico-radiological dilemma

Abstract

Acute transient diffusion-weighted image (DWI) restriction of the splenium of corpus callosum is reported in various medical conditions (encephalopathy, hypoglycemia, in patients on antiepileptic drugs) and in various neuro-infections. We report case of a 27-year-old woman who presented with acute onset persistent severe headache for last 3 days. Her headaches were hemicranial, severe and throbbing in nature, associated with nausea and photophobia. Her symptomatology mimicked ‘status migrainosus’, however she had no history of migraine in past. She was investigated in details and her MRI brain revealed a splenial hyperintense lesion which showed spontaneous resolution on follow up. It is imperative in such cases to identify and explore the reversible causes and manage accordingly before it results in irreversible brain injury.