Osmotic demyelination syndrome

Case contributed by Itziar Aza
Diagnosis almost certain


Deterioration of conscious level. Suspected encephalopathy.

Patient Data

Age: 65 years
Gender: Female

Central pontine hyperintensity on T2-FLAIR, without mass effect.

Diffusion restriction with "trident" configuration, with peripheral sparing.

Symmetric bilateral hyperintensity of the thalami and external capsule. 

Case Discussion

Patient had a history of alcohol abuse and suffered from chronic alcoholic hepatopathy. She was found with severe hyponatremia (103mEq/L) at the time of admission. Sodium levels were corrected following consensus guidelines, with clinical improvement. Nevertheless, 6 days after admission the patient presented with lower consciousness levels (Glasgow Coma Scale 3) and cervical tenderness.

Sodium levels, personal history of chronic alcoholism, clinical presentation and radiographic features make the diagnosis almost certain.


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