Presentation
Hospitalized patient with an electrolyte imbalance. Quadriparesis, muscle weakness, abnormal behavior, dysphagia.
Patient Data
T1WI hypointense and T2WI and FLAIR hyperintense lesions are seen in the central part of the pons. The lesion is intensely hypointense in ADC and intensely hyperintense in DWI. The rest of the brain parenchyma appears normal.
Case Discussion
The patient had a history of alcohol abuse and was admitted to the hospital with an electrolyte imbalance. The patient experienced quadriplegia, dysphagia, muscle weakness, and imbalance two days later (after the treatment started).
Imaging features and the clinical history suggest the diagnosis of osmotic demyelination syndrome.
Osmotic demyelination syndrome occurs as a result of the rapid correction of hyponatremia. Rapid changes in osmolarity result in disruption of the blood-brain barrier and activation of inflammatory cytokines. which leads to demyelination. Pons is the most vulnerable part of the brain, though it may involve other parts of the brain. So the preferred terms are pontine and extrapontine myelinolysis.
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