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Clinical Images Volume 10 Issue 4
Magnetic Resonance Imaging in Osmotic Demyelination Syndrome
Presaad Pillai,
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Joyce Pauline Joseph
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Department of Neurology, Kuala Lumpur Hospital, Malaysia
Correspondence: Presaad PILLAI, Kuala Lumpur Hospital, Department of Neurology, Kuala Lumpur, Malaysi
Received: June 12, 2020 | Published: July 6, 2020
Citation: Pillai P, Joseph JP. Magnetic Resonance Imaging in Osmotic Demyelination Syndrome. J Neurol Stroke. 2020;10(4):125. DOI: 10.15406/jnsk.2020.10.00424
Clinical image
A 52-year-old man on several anti-hypertensives including Hydrochlorothiazide and Spironolactone presented with confusion and intestinal obstruction. He had profound hyponatremia with serum sodium of 96 mmol/L; this was attributed to the diuretics he was prescribed. Clinical improvement were seen over the next six days with gradual correction of serum sodium at a rate of around 4 mmol/L/day, from 96 mmol/L to 124 mmol/L. However, over the following three days, serum sodium increased further from 124 mmol/L to 147 mmol/L. Approximately 48 hours after the rapid increase in serum sodium, his Glasgow Coma Scale decreased indicating low conscious level, thus necessitating intubation. Serum sodium levels stabilised thereafter, but there were no improvement in conscious level. The patient appeared to be in a ‘locked-in’ state. Magnetic Resonance Imaging (MRI) (shown below) revealed central pontine and extrapontine myelinolysis with T2 hyperintensity at the pons (Trident sign) (A) as well as the putamen and caudate nucleus (B) and restricted diffusion on Diffusion Weighted Imaging (DWI) mapping (C) and Apparent Diffusion Coefficient (ADC) mapping (D). These are radiological features, which has been described.1–3 Plasma exchange was done, but he showed no significant neurological recovery (Figure 1 & 2).
Acknowledgments
None.
Conflicts of interest
The author declares no conflicts of interest.
References
- Brown WD. Osmotic demyelination disorders: Central pontine andextrapontine myelinolysis. Curr Opin Neurol. 2000;13(6):691–697.
- Anthony M Alleman. Osmotic Demyelination Syndrome: Central Pontine Myelinolysis and Extrapontine Myelinolysis. Semin Ultrasound CT M. 2014;35(2):153–159.
- S Huq, M Wong, H Chan, et al. Osmotic demyelination syndromes: Central and extrapontine myelinolysis. J Clin Neurosci. 2007;14(7):684–688.
©2020 Pillai, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.