Osmotic Demyelination Syndrome – MRI Diagnosis: a Case Report

Czech version

Authors: M. Slanina ¹; J. Žižka ¹; L. Klzo ¹; J. Novotný ¹; P. Ryška ¹; Z. Špriňar ¹; J. Hons ²; M. Šenkeřík ³; P. Kunc ⁴
Authors‘ workplace: Radiologická klinika LF UK a FN Hradec Králové ¹; Psychiatrická klinika LF UK a FN Hradec Králové ²; Dětská klinika LF UK a FN Hradec Králové ³; Neurologická klinika LF UK a FN Hradec Králové ⁴
Published in: Cesk Slov Neurol N 2007; 70/103(3): 322-327
Category: Case Report

Overview

Central pontine myelinolysis (CPM) together with extrapontine myelinolysis (EPM) are also named osmotic demyelination syndrome (ODMS). The osmotic destruction of myelin sheaths in the pons and/or extrapontine localization occurs in this disease while neurons and their axons remain intact. The mechanism of the myelinolysis development is not well known yet. It is commonly found in association with mineral dysbalance (particularly hyponatraemia or its rapid correction), therefore chronic alcoholics or seriously malnourished patients are typically afflicted. Common symptoms are spastic quadruparesis, pseudobulbar paralysis, pseudocoma (locked-in syndrome), coma, and a few cases may also progress to death. MRI is of the main importance in the ODMS diagnosis. In the case of CPM, we can find T1 hypointense, T2, PD (proton density weighed images) and FLAIR (fluid attenuated inversion recovery) hyperintense lesion in the central pons whereas peripheral area and pyramidal tracts remain intact. There is either no enhancement or a ring-like peripheral enhancement after a contrast agent administration. DWI (diffusion weighed images) with ADC (apparent diffusion coefficient) allow to differentiate cytotoxic oedema, which can be present in ODMS, and vasogenic oedema. Similar imaging findings as those in ODMS can be also observed in ischaemia, astrocytoma, multiple sclerosis, some metabolic diseases, posterior reversible encephalopathy syndrome or mesial temporal sclerosis. The authors have presented their experience with 7 cases of ODMS diagnosed by MRI in their institution.

Key words:
central pontine myelinolysis (CPM) – extrapontine myelinolysis (EPM) – osmotic demyelination syndrome (ODMS) – magnetic resonance imaging (MRI)

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