Case 9: Pregnant? Who's Pregnant?: Memory Loss in a Young Woman

Constance Smith-Hicks, MD, PhD


May 26, 2005

Etiology of the Splenium Lesion

Vascular, infectious, toxic, autoimmune, metabolic, and neoplastic causes should all be investigated. However, we can easily rule out vascular causes because the lesion is midline and would require the unlikelihood that both posterior cerebral arteries are affected. Although similar lesions have been associated with influenza A infection, this would be unlikely given the normal cerebrospinal fluid findings. A neoplastic etiology is certainly possible but is ruled out by MRS. Autoimmune processes, such as acute disseminated encephalomyelitis or multiple sclerosis, are less likely given the appearance of only 1 lesion, which leaves toxic and metabolic processes remaining.

High on the list of possible toxic or metabolic etiologies is Marchiafava-Bignami disease. Signal changes in the splenium were first described in Italian red wine drinkers but have been documented in cases of malnutrition and extrapontine myelinolysis. The clinical features include impaired consciousness, symptoms of interhemispheric disconnection, dysarthria, and neuropsychiatric disorders. These processes are thought to result from osmotic damage, manifesting as edema on MRI.

The neurologist conducts a neurocognitive evaluation to further evaluate the patient's deficits. Although this examination is not standardized for the hearing impaired, in this case it reveals significant impairment that, given this patient's history of good academic performance, cannot be explained only on the basis of hearing deficit. She demonstrates difficulty learning new visual and verbal information and some slowness in executive functions. Finally, although she perceives the input and has good immediate recall, her delayed recall is impaired.

Given these deficits, where would you localize the lesion?

  1. Right frontal lobe

  2. Left parietal lobe

  3. Right temporal lobe

  4. Left temporal lobe

  5. Bilateral temporal lobes

View the correct answer.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.