Letter to the Editor
Interhemispheric lipoma associated with agenesis of the corpus callosum
Lipoma interhemisférico asociado a agenesia del cuerpo calloso
P.E. Jiménez Caballero
Facultativo Especialista de Área, Neurología, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, Spain
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Jiménez Caballero" "autores" => array:1 [ 0 => array:3 [ "nombre" => "P.E." "apellidos" => "Jiménez Caballero" "email" => array:1 [ 0 => "pjimenez1010j@yahoo.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Facultativo Especialista de Área, Neurología, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, Spain" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lipoma interhemisférico asociado a agenesia del cuerpo calloso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1138 "Ancho" => 952 "Tamanyo" => 133175 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cranial CT scan: hypodense image measuring 5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm in the area of the corpus callosum (arrow). It is surrounded by mural calcifications on both sides. Its density is indicative of fat content. Agenesis of the corpus callosum.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Intracranial lipomas are uncommon and benign congenital malformations that account for only 0.03% to 0.08% of all types of intracranial masses.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> They are usually located in the interhemispheric fissure, especially in the corpus callosum. Lipomas of the corpus callosum are frequently associated with other congenital malformations of that structure, such as agenesis, hypoplasia, or hypertrophy. Since half of all cases are asymptomatic, they are only diagnosed based on incidental findings in neuroimaging studies. In the remainder of the cases, they are associated with neurological symptoms such as psychomotor retardation, headache, epilepsy, and cerebral palsy.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our patient was a 23-year-old woman with a history of migraine without aura. Her gestation and birth were uneventful and psychomotor development was normal. She did not suffer from any febrile seizures, cranial trauma, or central nervous system infections during childhood. She had no family history of epilepsy or any other neurological disorders.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient visited the emergency department with symptoms of disorientation and buccofacial movements suggesting complex partial epileptic seizure. Neurological examination was normal. The cranial CT scan carried out in the emergency department (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) showed absence of the corpus callosum and a hypodense homogeneous lesion in its location. We observed curvilinear calcifications on both sides of the lesion. Findings suggested agenesis of the corpus callosum with interhemispheric lipoma. Treatment with valproic acid was prescribed. The electroencephalogram showed epileptiform activity in the left temporo-parietal region. Brain MRI (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) showed that the entire corpus callosum from the genu to the splenium was occupied by tissue that was hyperintense on all sequences, with the exception of the fat suppression sequence. The sagittal sequence showed bands of tissue that may correspond to remnants of the normal corpus callosum located between the lipomatous areas. We also observed slight dilation of the posterior horns of both lateral ventricles.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The patient received several antiepileptic drugs in different combinations, but seizure control was never achieved. Since that time we have performed several routine brain MRI scans and the lesion has remained unchanged.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Lipoma of the corpus callosum is a congenital disorder which probably arises due to poor differentiation of the meningeal tissue. Agenesis of the corpus callosum is a type of cerebral dysraphism in which the neural tube does not close properly.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This disorder is usually accompanied by epilepsy, which may manifest as either partial simple seizures or complex seizures.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The origin of seizures is unknown, but they could stem from an epileptogenic focus caused when the cerebral cortex is invaded by the collagenous capsule of the lipoma, or from interhemispheric disconnection.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The appearance of the corpus callosum lipoma on the cranial CT scan is quite typical, with the low attenuation seen only in adipose tissue. In addition, it is surrounded by bilateral, rounded mural calcifications. After administration of contrast, the lesion showed no changes. In the brain MRI the lesion presents characteristics of fatty tissue, with a hyperintense signal in both T1- and T2-weighted studies.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> During complete agenesis of the corpus callosum, the lateral ventricles are far apart and never converge. They often have small frontal horns and disproportionally thick occipital horns (colpocephaly).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Differential diagnosis must be performed with epidermoid cyst, teratoma, craniopharyngioma, and epidermoid tumours.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The cystic content of the craniopharyngioma may have a fat-like density, but the appearance is complex with atypical calcifications. Teratomas and dermoid cysts are usually heterogeneous because they contain other tissues in addition to fat. Dermoid cysts are generally located in the cerebellopontine angle, parahypophyseal region, or the fourth ventricle. The density of the lesion in the cranial CT scan is similar to that of cerebrospinal fluid.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Some cases of interhemispheric lipomas are associated with agenesis of the corpus callosum resulting from connatal infection with cytomegalovirus or X chromosome deletion, although most are idiopathic.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Surgical treatment is not recommended except in cases of secondary hydrocephalus that require ventriculoperitoneal shunting. Surgery is not advisable in other cases due to their abundant vascularisation, capsule infiltration, and adherence to adjacent tissue, plus the fact that these tumours do not grow and often have few clinical consequences. Even when surgery is performed, epileptic seizures rarely cease. Nevertheless, other authors have had favourable results using microsurgery and a CO<span class="elsevierStyleInf">2</span> laser.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Jiménez Caballero PE. Lipoma interhemisférico asociado a agenesia del cuerpo calloso. Neurología. 2012;27:515–7.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1138 "Ancho" => 952 "Tamanyo" => 133175 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cranial CT scan: hypodense image measuring 5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm in the area of the corpus callosum (arrow). It is surrounded by mural calcifications on both sides. Its density is indicative of fat content. Agenesis of the corpus callosum.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2092 "Ancho" => 951 "Tamanyo" => 156411 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Brain MRI. (a) T1-weighted sagittal slice: hyperintense lesion in the area of the corpus callosum, which is absent. (b) T2-weighted axial slice: hyperintense lesion in the corpus callosum area. Agenesis of the corpus callosum with separation of the lateral ventricles.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intracraneal tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Bailey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1933" "editorial" => "Charles C Thomas Publisher" "editorialLocalizacion" => "Springfield III" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lipomas of the corpus callosum and epilepsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H. 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| 2020 May | 58 | 12 | 70 |
| 2020 April | 53 | 2 | 55 |
| 2020 March | 61 | 5 | 66 |
| 2020 February | 70 | 8 | 78 |
| 2020 January | 107 | 11 | 118 |
| 2019 December | 53 | 10 | 63 |
| 2019 November | 62 | 10 | 72 |
| 2019 October | 58 | 9 | 67 |
| 2019 September | 62 | 3 | 65 |
| 2019 August | 52 | 5 | 57 |
| 2019 July | 69 | 21 | 90 |
| 2019 June | 91 | 27 | 118 |
| 2019 May | 321 | 62 | 383 |
| 2019 April | 150 | 43 | 193 |
| 2019 March | 31 | 8 | 39 |
| 2019 February | 52 | 16 | 68 |
| 2019 January | 46 | 13 | 59 |
| 2018 December | 42 | 10 | 52 |
| 2018 November | 40 | 11 | 51 |
| 2018 October | 66 | 13 | 79 |
| 2018 September | 60 | 11 | 71 |
| 2018 August | 14 | 21 | 35 |
| 2018 July | 16 | 4 | 20 |
| 2018 June | 12 | 11 | 23 |
| 2018 May | 18 | 12 | 30 |
| 2018 April | 24 | 8 | 32 |
| 2018 March | 25 | 3 | 28 |
| 2018 February | 16 | 6 | 22 |
| 2018 January | 26 | 7 | 33 |
| 2017 December | 15 | 4 | 19 |
| 2017 November | 19 | 6 | 25 |
| 2017 October | 19 | 10 | 29 |
| 2017 September | 25 | 24 | 49 |
| 2017 August | 21 | 4 | 25 |
| 2017 July | 11 | 9 | 20 |
| 2017 June | 26 | 20 | 46 |
| 2017 May | 27 | 19 | 46 |
| 2017 April | 16 | 21 | 37 |
| 2017 March | 22 | 19 | 41 |
| 2017 February | 22 | 10 | 32 |
| 2017 January | 26 | 8 | 34 |
| 2016 December | 22 | 14 | 36 |
| 2016 November | 23 | 13 | 36 |
| 2016 October | 47 | 17 | 64 |
| 2016 September | 51 | 6 | 57 |
| 2016 August | 33 | 14 | 47 |
| 2016 July | 20 | 4 | 24 |
| 2016 June | 39 | 15 | 54 |
| 2016 May | 29 | 30 | 59 |
| 2016 April | 36 | 24 | 60 |
| 2016 March | 40 | 27 | 67 |
| 2016 February | 30 | 18 | 48 |
| 2016 January | 24 | 25 | 49 |
| 2015 December | 13 | 21 | 34 |
| 2015 November | 27 | 22 | 49 |
| 2015 October | 26 | 23 | 49 |
| 2015 September | 44 | 20 | 64 |
| 2015 August | 55 | 18 | 73 |
| 2015 July | 50 | 6 | 56 |
| 2015 June | 34 | 5 | 39 |
| 2015 May | 26 | 14 | 40 |
| 2015 April | 37 | 16 | 53 |
| 2015 March | 29 | 14 | 43 |
| 2015 February | 29 | 10 | 39 |
| 2015 January | 46 | 7 | 53 |
| 2014 December | 44 | 11 | 55 |
| 2014 November | 16 | 4 | 20 |
| 2014 October | 34 | 5 | 39 |
| 2014 September | 49 | 5 | 54 |
| 2014 August | 52 | 2 | 54 |
| 2014 July | 38 | 5 | 43 |
| 2014 June | 29 | 2 | 31 |
| 2014 May | 31 | 4 | 35 |
| 2014 April | 28 | 3 | 31 |
| 2014 March | 29 | 5 | 34 |
| 2014 February | 26 | 5 | 31 |
| 2014 January | 18 | 4 | 22 |
| 2013 December | 32 | 3 | 35 |
| 2013 November | 42 | 12 | 54 |
| 2013 October | 85 | 6 | 91 |
| 2013 September | 58 | 7 | 65 |
| 2013 August | 81 | 6 | 87 |
| 2013 July | 22 | 1 | 23 |
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