Answer of September 2005

Clinical History:

61years old male presents with altered mental status and severe electrolyte disturbances. 

Diagnosis:

Osmotic myelinolysis

Discussion:

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.