Case - Osmotic Demyelination Syndrome (Stroke Mimic)
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Osmotic demyelination syndrome,
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or central pontine myelinolysis can also mimic stroke.
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These patients have profound hyponatremia.
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Frequently, their alcoholics are debilitated,
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and then they have rapid correction of sodium.
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The patients present with encephalopathy,
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pseudo bulbar palsy, spastic quadriparesis,
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sometimes even coma.
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There's oligodendrocyte injury
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and there's restricted diffusion
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due to myelin vacuolization.
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It involves the central pons,
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there can also be extra pontine locations.
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Frequently, the deep gray nuclei
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and subcortical white matter.
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So, here are images of central pontine myelinolysis.
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You have this classic central pons involvement
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with restricted diffusion.
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And just by contrast, this is what an acute
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infarct usually looks like.
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It's usually in the hemipons,
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not in the central pons.
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This is an example of osmotic demyelination syndrome,
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also known as central pontine myelinolysis
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and extra pontine myelinolysis.
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And these are images of a 46-year-old female,
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alcoholic, who was found with altered mental status
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and severe hyponatremia.
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And then, she had rapid correction of her sodium
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and progressed to a comatose state.
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These are the diffusion weighted images
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and the ADC maps.
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And you can see this classic central
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pontine restricted diffusions.
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It's been called a trident configuration
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in the central pons,
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again, that it's indistinction to a hemipons lesion,
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which is what you would see with infarct.
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And then, this patient also has involvement
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of her bilateral lentiform nuclei,
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her caudate nuclei, and the bilateral thalami.
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Let's take a look at the FLAIR images.
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There's extensive FLAIR hyperintensity
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in the same lesions.
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Again, the central pons and the deep grey nuclei,
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including the lentiform nucleus,
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the caudate nucleus, and thalami.
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And this is a classic case of
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osmotic demyelination syndrome.
Pamela W Schaefer, MD, FACR
Professor of Radiology, Vice Chair of Education
Massachusetts General Hospital
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