Clinical History 61years old male presents with altered mental status and severe electrolyte disturbances. Diagnosis: Osmotic myelinolysis Comment : MR axial T2 and coronal T2* images show hyperintensity involving the central pons with sparing of the peripheral fibers. Multiple areas of T2 hyperintensity were seen with bilateral symmetrical involvement of the basal ganglia and, to a lesser extend the subcortical white matters. Findings are classical of osmotic myelinolysis with central pontine and extra-pontine involvement. On admission, patient was severely hyponatremic with serum sodium concentration less than 100mmol per liter. He remained comatose and required long period of intensive care. PREVIOUS CASES HOME COMMENTS

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