Callosal warning syndrome

Objective: To report the clinical and imaging findings in a patient with an initial fluctuating disconnection syndrome due to corpus callosal ischemia that ultimately culminated in infarction with persistent symptoms. Case report: A 40-year-old, hypertensive, right-handed man presented with transient, stereotyped symptoms of corpus callosal disconnection (intermanual conflict, apraxia, dysgraphia and construction difficulties in his left hand). Serial magnetic resonance imaging scans demonstrated the ischemic nature of the initial fluctuating symptoms and later showed callosal infarction when the symptoms were persistent. Magnetic resonance angiogram did not reveal significant stenosis or occlusion of the internal carotid or proximal portion of anterior cerebral arteries. Patient received standard treatment for ischemic stroke and at follow-up 1 month later, had mild left hand apraxia, dysgraphia and construction difficulties. Conclusion: The case highlights the unusual occurrence of crescendo transient ischemic attacks culminating in infarction in the location of corpus callosum. We have termed this novel stroke syndrome as 'callosal warning syndrome' as the temporal profile was quite indistinguishable from that of relatively well-known stroke warning syndromes in the location of internal capsule and pontine tegmentum.