Objective:

To illustrate a rare manifestation of SARS-CoV-2, we present a case of cytotoxic lesion of the splenium of the corpus callosum (CLOCC) causing vision disturbances with postural changes.

Background:

SARS-CoV-2 infection can affect the central nervous system, leading to conditions such as meningoencephalitis, acute cerebellitis, acute demyelinating encephalomyelitis, stroke etc. Rarely, it can cause Mild Encephalopathy with Reversible Splenial Lesions (MERS), also known as cytotoxic lesions of the corpus callosum (CLOCC). Here, we present a case of SARS-CoV-2-associated CLOCC, manifesting with visual disturbances.

Design/Methods:

Case report

Results:

A 26-year-old male presented with a 3-day history of prodromal symptoms, including malaise, sore throat, and severe coughing, associated with SARS-CoV-2 infection. Although these symptoms improved, he began experiencing episodes of abnormal visual disturbances. He described these episodes as "white-out vision with a small central scotoma," lasting 15 to 20 seconds, followed by a "blurred smudge" that resolved spontaneously. Each episode was preceded by a tingling sensation in both hands and occurred every 2 to 3 minutes, persisting while standing or sitting and subsiding in the supine position. He experienced multiple episodes throughout the day. An MRI of the brain without contrast revealed a focus of diffusion restriction in the midline of the splenium of the corpus callosum, consistent with a cytotoxic lesion of the corpus callosum (CLOCC). MR venogram and CT angiography of the head and neck showed no abnormalities. Due to the patient's symptom improvement and the temporal association with SARS-CoV-2, CSF analysis was deferred. A follow-up MRI with contrast 4 weeks later demonstrated complete resolution of the lesion.

Conclusions:

This case highlights a rare manifestation of SARS-CoV-2-associated cytotoxic lesion of the corpus callosum (CLOCC), presenting as visual disturbances triggered by postural changes.