Central Pontine Myelinolysis

central pontine myelinolysis

The FLAIR MR image above shows changes typical of central pontine myelinolysis.

Also known as osmotic demyelination, central pontine myelinololysis is an acute demylination of the white matter tracts traversing the pons, seen in the setting of sudden osmotic changes, typically the rapid correction of hyponatraemia. Occasionally extrapontine white matter is also affected, in the basal ganglia, mid brain and subcortical white matter.

Clinically CPM presents with:

* quadriparesis
* pseudobulbar palsy
* variable levels of consciousness
* coma and death

CT demostrates low density crossing the midline in the pons. This same region demonstrates high T2 signal and restricted diffusion. Occasionally gadolinium enhancement is also demonstrated, just as in the acute phase of an MS plaque.

For more images of the same case please visit Radiopaedia.org here.

Reference:
1. Medcyclopaedia.com

Credit: Dr Frank Gaillard