Abstract Details

Title Reversible Lesion of the Splenium of the Corpus Callosum Associated with Postpartum Thiamine Deficiency

Topic General Neurology

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 6-004

Objective We write this case report to describe an unusual clinical and radiographic presentation of thiamine deficiency in a post-partum young woman.

Background Pregnancy is a high thiamine requirement state, especially during the third trimester, when thiamine is sequestered in by the fetus and placenta. Most commonly involved brain sites in thiamine deficiency are mammillary bodies, medial thalami, periaqueductal area and tectal plate. Involvement of the splenium of the corpus callosum is extremely rare.

Design/Methods Case Report

Results This is a 22-year-old female with no past medical history. She had delivered a healthy baby three weeks prior with an uncomplicated vaginal delivery. She presented to us with brief episodes of visual disturbance. Per her, her vision seemed as if she were looking through a kaleidoscope. These episodes would last for a few minutes to an hour. She had 6-7 such episodes within 3 days. No other focal neurological complaints or deficits were reported. She first underwent an ophthalmologic evaluation which was negative. An MRI brain with and without contrast showed a restricted diffusion lesion in the splenium of the corpus callosum. This lesion was hyperintense on the T2 and T2-FLAIR, hypointense on ADC and T1 sequences and did not enhance with contrast. Stroke work up included an MR angiogram and venogram, lipid panel, HbA1C and echocardiogram. All were unremarkable. Thiamine resulted as low at 3 nmol/L. She was given a single dose of IV thiamine and her symptoms dramatically improved. She was discharged on oral thiamine supplementation. Three-month follow up MRI brain revealed no lesion.

Conclusions The differential of isolated splenium lesions are stroke/vasculitis, malignancy, trauma, drug abuse and metabolic abnormalities. The splenium of corpus callosum involvement is extremely rare in the thiamine deficiency. The lesion is reversible with thiamine replacement. We recommend routine thiamine supplements in pregnancy.

Authors/Disclosures
Rutvij J. Shah, MD, MBBS (Piedmont Columbus Regional) PRESENTER	No disclosure on file
Alan Little, MD (WK Neurology Consultants)	Dr. Little has received personal compensation for serving as an employee of Willis Knighton Health System. Dr. Little has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion .