Corpus callosum infarction in uncontrolled diabetes mellitus

Excerpt

A 40-year-old woman with no previous medical illness presented with sudden onset of left sided body weakness and facial asymmetry for two days. On examination, she had left lower facial palsy and left hemiparesis with muscle power of MRC grade 2/5. The higher cortical function and sensory modalities were normal. There were no visual disturbance or features of connective tissue disease. Non-contrasted CT brain showed hypodensity in the right corpus callosum. Magnetic resonance imaging (MRI) of the brain revealed hyperintense T2/FLAIR signals in corpus callosum with restricted diffusion (Fig. 1). There were also evidence of lacunar infarcts in the right corona radiata and putamen. MR angiogram of the brain showed atherosclerotic disease with focal stenosis of the right A1 segment. Electrocardiogram, echocardiogram and 24 h Holter monitoring were unremarkable. She was found to have diabetes mellitus with fasting serum glucose of 16.2 mmol/L and HbA1c of 11.7%. Peripheral blood count, renal and liver function, erythrocyte sedimentation rate were normal. Anti-nuclear antibody, anti-phospholipid antibodies, serum aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies were not detected. The diagnosis of corpus callosum infarction was made and she was treated with oral aspirin, atorvastatin and subcutaneous insulin. Despite inpatient rehabilitation, she remained disabled with modified Rankin scale of 4/6 after one month.

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