Question 2590
{"accessible":true,"alternatives":[{"id":12710,"text":"acute lacunar infarct"},{"id":12714,"text":"diffuse midline glioma"},{"id":12713,"text":"multiple sclerosis"},{"id":12711,"text":"osmotic demyelination syndrome"},{"id":12712,"text":"vigabatrin toxicity"}],"archived":false,"correctAlternativeId":12711,"explanation":"\u003cp\u003eThe central region of pontine diffusion restriction is typical of osmotic demyelination syndrome. A frequent supporting clinical history is a patient with alcoholism or other cause of malnutrition, found to have hyponatremia, who receives nutrition in the hospital and correction of electrolyte disorders. Osmotic demyelination syndrome usually develops a few days into hospitalization when the sodium level of someone with chronic hyponatremia is overly rapidly corrected.\u003c/p\u003e\u003cp\u003eAcute infarcts due to perforating arteries of the pons typically do not cross the midline. Basilar artery occlusion could cause bilateral pontine infarcts but the shape would not be so symmetric and confluently central, sparing corticospinal tracts as in this case.\u003c/p\u003e\u003cp\u003eDiffuse midline glioma is expansile.\u003c/p\u003e\u003cp\u003eMultiple sclerosis usually causes ovoid lesions in a perivenular distribution.\u003c/p\u003e\u003cp\u003eVigabatrin toxicity is a disorder of children receiving this medication for infantile spasms. The distribution of signal abnormality involves the globi pallidi, dorsal brainstem (central tegmental tracts), and dentate nuclei.\u003c/p\u003e","id":2590,"imageUrl":"https://prod-images-static.radiopaedia.org/images/54006810/3d0835eef027efe73f75b89a00014e9a0eb4282fef6f5c4b10f76d6f6700e717_big_gallery.jpeg","imageAttribution":{"kind":"case","rID":84764},"imageAttributionCaseInfo":{"title":"Osmotic demyelination syndrome","contributor_name":"Saad Ahmed Saad Hassan","contributor_param":"saad-ahmed-saad-hassan","case_rid":84764,"case_param":"osmotic-demyelination-syndrome-13"},"firstQuestionPath":"/questions/2590","nextQuestionPath":"/articles/diffuse-midline-glioma-h3-k27-altered/questions/2138","relatedArticles":[{"id":1700,"title":"Multiple sclerosis","link":"/articles/multiple-sclerosis?lang=us"},{"id":32265,"title":"Brainstem stroke syndromes","link":"/articles/brainstem-stroke-syndromes?lang=us"},{"id":1077,"title":"Osmotic demyelination syndrome","link":"/articles/osmotic-demyelination-syndrome?lang=us"}],"alsoUsedIn":[{"id":1397,"kind":"RestrictedPage","title":"Page 1397 (in no courses)","link":"https://radiopaedia.org/admin/restricted_pages/1397"},{"id":2238,"kind":"Course","title":"Toxic \u0026 Metabolic Brain Disorders in Adults - page 2238","link":"https://radiopaedia.org/courses/toxic-and-metabolic-brain-disorders/pages/2238"},{"id":2238,"kind":"Course","title":"Toxic \u0026 Metabolic Brain Disorders in Adults Peer Review - page 2238","link":"https://radiopaedia.org/courses/toxic-and-metabolic-brain-disorders-peer-review/pages/2238"}],"stem":"\u003cp\u003eA 45-year-old man is hospitalized for alcohol withdrawal. A few days into the hospitalization, he develops disordered movement and is assessed with MRI. What is the most likely diagnosis?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/2590"}],"attemptsPercentages":[{"alternativeId":"12713","percentage":2},{"alternativeId":"12710","percentage":1},{"alternativeId":"12712","percentage":2},{"alternativeId":"12714","percentage":1},{"alternativeId":"12711","percentage":94}],"promptToLogin":false,"questionManager":false,"articleId":"diffuse-midline-glioma-h3-k27-altered"}