Osmotic demyelination syndrome
Deterioration of conscious level. Suspected encephalopathy.
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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.
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.
- Howard SA et al. Osmotic Demyelination Syndrome. RadioGraphics 2009; 29:933–938.
- Ruzek KA, Campeau NG, Miller GM. Early Diagnosis of Central Pontine Myelinolysis with Diffusion-Weighted Imaging. AJNR Am J Neuroradiol 2004 25:210–213.