Central pontine myelinolysis

Case contributed by Dr Bilal Alam

Presentation

A patient who had developed quadriparesis and aphasia 2-3 days after dropping her GCS from 14/15 to 10/15. Patient was noted to be hypokalemic which was corrected before these events transpired.

Patient Data

Age: 50
Gender: Female

A large area of hypoattenuation is clearly seen within the pons. This is consistent with either a pontine infarct or central pontine myelinolysis.

MRI

A focal area of increased signal intensity is seen in the pon with restricted diffusion. However on closer examination there is clear sparing of the periphery and corticospinal tract regions. These findings favor the diagnosis of central pontine myelinolysis over a pontine infarct.

Case Discussion

Main differentials of any lesion with radiological similarities to this include central pontine infarct or central pontine myelinolysis. However it was felt that this was central pontine myelinolysis given:

  • the relatively slow onset of her drowsiness
  • the subsequent symptoms (including quadriparesis)
  • large, well defined, rounded, symmetrical pontine lesion with sparing at the peripheries and the corticospinal tracts
  • the presence and correction of hypokalemia preceding the events

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