Cytotoxic lesions of the corpus callosum secondary to hypoxic brain injury in an adult: a case report

Background Cytotoxic lesions of the corpus callosum (CLOCCs) is characterised by reversible restricted diffusion in the splenium of the corpus callosum and is most commonly associated with infection, seizures and metabolic disturbances in paediatric populations. Hypoxic injury as a cause of CLOCCs in adults is rare; we describe a case occurring post-cardiac arrest. Case presentation A White male in his 70s underwent coronary artery bypass grafting and subsequently experienced two episodes of cardiac arrest secondary to graft occlusion. After prolonged resuscitation, he developed new-onset delirium upon emergence from sedation. MRI of the brain performed 20 day post-arrest revealed a focal lesion in the splenium of the corpus callosum with restricted diffusion, most consistent with CLOCCs, although an ischaemic aetiology could not be excluded in the absence of follow-up imaging. Despite intensive treatment, the patient succumbed to multiple organ failure 1-month post-arrest. Conclusions CLOCCs should be considered in the differential diagnosis of persistent delirium following cardiac arrest in adults. Accurate recognition of this entity is important to avoid misdiagnosis, guide appropriate workup and prevent premature prognostication.