Answer of February 2001

Clinical History:

renal failure patient admitted for hyponatremia and hyperkalemia. Initial CT brain is normal. Condition deteriorates 1 week later. MR performed 3 weeks later.

Figure 1 (T1WI)
Figure 2 (T2WI)
Figure 3 (T2WI)

What is your diagnosis?

                            Figure 1                                                                        Figure 2

                            Figure 3

Diagnosis:

Osmotic Myelinolysis (central pontine myelinolysis & extrapontine myelinolysis)

Discussion:

Figure 1 & 2 MR shows a large T1 hypo & T2 hyperintense lesion in the central pon.

Figure 3 There are also T2 hyperintense lesions in the bilateral basal ganglia and thalami.