Osmotic demyelination syndrome: pontine and extrapontine involvment

Case contributed by Dr Varun Babu


63 year old female with hypothyroidism was one day found unresponsive in her chair after a meal. She complained of weakness of the left half of her body and was admitted to a local hospital. Routine blood workup revealed hyponatremia and was treated with correction. After 10 days she was referred to a higher center for further evaluation. In view of history of left sided weakness of 10 days which partially improved, she underwent an acute stroke CT/MR protocol.

Patient Data

Age: 65
Gender: Female

Diffuse hypodense areas seen involving bilateral deep nuclei and pons. 

T2 bright signals from bilateral caudate head and basal ganglia, central pons with diffusion restriction. The sparing of ventrolateral pons is characteristic. 

Case Discussion

On viewing the imaging findings, history of recent treatment was looked into. Hyponatremia at time of admission was 104 mEq, corrected to 121 mEq within 24hrs. 

In the background of such a history with normal MRA, a diagnosis of central pontine myelinolysis with extra pontine myelinolysis involving bilateral basal ganglia was made. These conditions are now grouped under the term osmotic demyelination syndrome

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Case information

rID: 17674
Published: 3rd May 2012
Last edited: 13th Aug 2019
Inclusion in quiz mode: Included

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