Abstract
Background Varying clinical presentations ranging from headaches and vomiting to seizures present to clinicians (GPs, ED, Neurologists) for further evaluation. In this setting, neuroimaging identifies corpus callosum lesions, described as CLOCCs (Cytotoxic lesions of the corpus callosum).
Case Presentation A 20-year-old female presented with 3 days of a constant, worsening headache with associated hyperacusis. This was on a background of having headaches for the past few years intermittently. These headaches previously came on every few weeks and were of a moderate intensity but subsided after a few hours. She never previously sought treatment for her headaches. She only presented to her GP for review after 3 days of persistent headache with new hyperacusis. Her MRI Brain (as requested by GP) was formally reported to demonstrate CLOCCs.
The aetiology of CLOCCs includes infection, underlying CNS malignancy, epileptiform focus, medication changes and intracerebral bleeds (subarachnoid haemorrhage).
The patient's past medical history only included depression, for which she was on the same dose of SSRI for the past 3 years.
A thorough systems review of the patient and pertinent investigations, including EEG, were negative and no aetiology was identified. The patient's repeat MRI (6 weeks post initial) showed complete resolution of CLOCCs.
Conclusion CLOCCs are an interesting radiological finding, which clinicians should be aware of, given the multiple aetiologies. Thorough history, clinical examination and relevant investigations to exclude sinister causes are required. CLOCCs have varied clinical presentations, and reassuringly are mostly benign, self-resolving entities, as demonstrated on repeat neurological imaging.
