![]() Magnetic resonance imaging revealed a conspicuous splenial lesion during the clinical syndrome. The patient was referred to our neurological surgery and neurology departments for consultation and further workup. ![]() The differential diagnosis of this lesion included neoplasm, gliosis, traumatic axonal injury, Susac syndrome, a metabolic or infectious derangement, Marchiafava Bignami disease, and demyelination. Results of a comprehensive metabolic panel including liver functions, electrolyte levels, blood glucose level, complete blood cell count, antiphospholipid antibodies, lupus anticoagulants, protein C and S, antithrombin III, factor V Leiden, VDRL test, cryptococcal antigen, antinuclear antibody, rheumatoid factor, erythrocyte sedimentation rate, Lyme titer, serum protein electrophoresis, and immunofixation were all normal. Cerebrospinal fluid IgG index and synthesis rate were normal, and there was no evidence of oligoclonal bands. A magnetic resonance scan of the cervical and thoracic spinal cord was normal. There was no evidence of gadolinium enhancement. The abnormality was identified on T2-weighted, fluid-attenuated inversion recovery, and diffusion-weighted sequences ( Figure 1). Magnetic resonance imaging at an outside institution at the time of initial presentation revealed a solitary, well-circumscribed hyperintensity localized to the splenium of the corpus callosum (CC). She did have a history of a fall from an all-terrain vehicle at age 14 years, but she did not sustain any injuries. There were no associated neurological concomitants such as headache, weakness, numbness, or post-ictal fatigue, and there was no significant medical history. The initial event lasted approximately 60 minutes, and subsequent episodes were substantially shorter yet indistinguishable in character. This visual fragmentation occurred paroxysmally as stereotyped episodes over a 1-week period, and it involved both eyes. She described normal vision that was recurrently punctuated by a stereotyped illusion characterized by the perception that she was “looking through a kaleidoscope.” Whole-field visual scenes were fragmented into component parts while the patient was still able to accurately identify the visual object. Both the visual fragmentation and the lesion in the corpus callosum resolved once the patient stopped receiving diet pills.Ī 17-year-old, right-handed young woman presented with a history of highly unusual yet conspicuous changes in her vision. ![]() Results Sympathomimetic-induced metabolic derangements can be associated with reversible lesions within the brain.Ĭonclusions We hypothesize that the visual fragmentation was a manifestation of a migraine triggered by sympathomimetic-containing diet pills, and that the transient lesion in the corpus callosum was a manifestation of a reversible metabolic derangement. Main Outcome Measures Clinical and radiographic improvement. Intervention Withdrawal of the medication resulted in the cessation of the episodes and normalization of the magnetic resonance image. Her brother has a history of migraine and experienced a similar episode while using illicit stimulant agents. Patient A 17-year-old adolescent girl who developed an episode of kaleidoscopic vision while using sympathomimetic-containing diet pills that was associated with a reversible lesion of the splenium of the corpus callosum. Setting The University of Texas Southwestern Medical Center, Dallas. Objective To describe a patient with a “kaleidoscopic” visual illusion who was found by magnetic resonance imaging to have a transient lesion in the splenium of the corpus callosum. Shared Decision Making and Communicationīackground Sympathomimetic-induced metabolic derangements within the central nervous system can result in conspicuous changes in neurological functioning and corresponding radiographic abnormalities that can be reversible.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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