[Transient high-intensity T2 signal in the splenium of the corpus callosum in a non-epileptic patient]. / Hypersignal T2 transitoire du splenium du corps calleux chez une patiente non épileptique.

Transient splenial lesions of the corpus callosum have been mainly reported in epileptic patients. We report the case of a non-epileptic woman with bipolar affective disorder treated by oxcarbazepine which was withdrawn because of a mild hyponatremia (128 mmol/l). A confusional state followed withdrawal and the electroencephalogram was free of spike or sharp waves. Brain MRI showed a single splenial lesion of the corpus callosum revealed by a high intensity T2 signal on FLAIR and diffusion sequences. Because of a major depressive episode, twelve sessions of electroconvulsive therapy were performed and yielded clinical improvement. A second brain MRI performed 5 weeks later was normal. The relevances of this cases are the non-epileptic status of the patient, the drug incriminated (oxcarbazepine), and the normalisation of brain MRI despite electroconvulsive therapy. Different mechanisms of this brain MRI abnormality are discussed including the sudden withdraw of oxcarbazepine. Prognosis of transient splenial lesions of the corpus callosum is good. Clinicians should search for recent metabolic disorders and therapeutic modifications.

Clinical evolution after self-induced or accidental traumatism: a controlled study of the extent and the specificity of suicidal catharsis.

BACKGROUND: The cathartic effect has been related to the short-term decrease of depressive symptomatology following the suicide attempt. This study aimed to clarify the extent of this clinical improvement to non self-induced traumas and other suicidal dimensions. METHODS: Twenty-six recent suicide attempters were compared with 21 control subjects admitted to the surgical ward after an accident-induced trauma. They completed several assessments the day after the admission and one week after discharge: Hamilton and Carroll Depression scales, Barratt Impulsivity Scale, Hopelessness scale, State-Trait Anxiety Inventory, MMPI (abbreviated version), Global Assessment Scale. RESULTS: Depression, anxiety-state, two sub-scales of the MMPI (Hysteria, Depression) and general functioning improved significantly in the suicide attempters group. Measures of impulsivity and hopelessness remained stable during the follow-up. LIMITATIONS: These results cannot not be generalized to all suicide attempters and we did not take account of the lethality and severity of the suicidal method used. CONCLUSION: Our study supports the specific role of deliberate self-aggression in the cathartic effect and the trait value of both impulsivity and hopelessness.