Central pontine myelinolysis

Case contributed by Bruno Di Muzio
Diagnosis probable


Patient with diabetes and chronic nephropathy, evolves pseudobulbar palsy four days after leaving the ICU.

Patient Data

Age: 62
Gender: Female

MRI Brain


Oval symmetrical lesion on pons that has hypointense signal on T1 and hyperintense on T2 and FLAIR and no mass effect. There is gadolinium enhancement on T1 C+. 

In some sequences it is possible to identify a hyperintense “trident-shaped” central pontine abnormality, with sparing of the ventrolateral pons and corticospinal tracts.

CT scan performed days earlier


Reviewing the two days ago CT you can check tenuous/doubtful central hypoattenuation on pons. Limitation of the imaging method, not reported.

Case Discussion

Central pontine myelinolysis (also known as osmotic demyelination, as it not only affects the pons) refers to acute demyelination of the white matter tracts traversing the pons.

Occasionally gadolinium enhancement is also demonstrated, as in this case, just as in the acute phase of an multiple sclerosis plaque.

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