Presentation
Severe peripheral tetraparesis, predominantly in lower extremities, skew deviation (Hertwig-Magendie syndrome), sensory and cerebellar ataxia, head and intentional tremor, dysarthria, dysphonia, scanning speech, and dysfunction of pelvic organs. History of alcohol abuse.
Patient Data
Large lesion consistent with demyelination in the central pons, that is hypointense on T1, and hyperintense on T2, FLAIR, and ADC sequences.
Case Discussion
The patient had a history of chronic alcohol abuse. After the last acute poisoning, she fell into a coma and was transported to ICU. In 5 days of infusive therapy, she was discharged with the symptoms written above.
Considering the history and typical radiological findings, the diagnosis of the central pontine myelinolysis (osmotic demyelination syndrome) seems obvious.