Cytotoxic Lesion of the Corpus Callosum in a Patient with Acute-on-chronic Lithium Toxicity.
Takeshi Miura, Teruki Kuroshita, Yosui Higuchi et al.
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Case in brief
A 30-year-old woman with bipolar disorder developed impaired consciousness and myoclonus while taking lithium regularly. MRI showed a hyperintense lesion in the splenium of the corpus callosum, consistent with a cytotoxic lesion of the corpus callosum (CLOCC). Her serum lithium level was 3.54 mmol/L, and acute-on-chronic lithium toxicity was diagnosed. She received hemodialysis and supportive care, followed by clinical and radiological recovery.
What made this case unusual
The splenial CLOCC provided a neuroimaging finding in the setting of acute-on-chronic lithium toxicity, linking a characteristic callosal lesion with lithium toxicity in this patient.
Diagnostic / clinical pearl
In a patient taking lithium who presents with impaired consciousness or myoclonus, a splenial CLOCC on MRI may support consideration of lithium toxicity alongside serum lithium measurement.