Osmotic demyelination syndrome

Case contributed by Joe Cyriac
Diagnosis probable

Presentation

Intractable vertigo, lightheadedness, and dizziness for 4 days.

Patient Data

Age: 65 years
Gender: Male

There is confluent low-attenuation in the central pons which is suspicious for central pontine myelinolysis/osmotic demyelination syndrome.

As noted on the CT study there is a large focus of non-enhancing T2 signal hyperintensity involving the central pons. This measures 1.9 x 1.2 cm in the axial plane and extends over a craniocaudal height of 1.8 cm. No associated restricted diffusion.

Impression:

Large focus of non-enhancing signal abnormality in the central pons, corresponding to low attenuation lesion on CT. The appearance is most suggestive of osmotic demyelinating syndrome (central pontine myelinolysis/CPM).

Case Discussion

This case most likely demonstrates osmotic demyelination syndrome also known as central pontine myelinolysis. MRI remains the gold standard modality in imaging when compared to non-contrast CT.

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