MRI Findings in Osmotic Demyelination Syndrome- A Report of Two Cases

Abstract

Osmotic demyelination syndrome is a condition seen due to the loss of normal myelin in the central nervous system. Multiple etiologies have been identified as causing this condition, however, the most reported cause is the rapid correction of hyponatremia. Different levels of the central nervous system are involved in the condition. Despite variable etiologies and clinical outcomes of the disease, the Magnetic Resonance Imaging (MRI) findings are well-established and characteristic. Hereby, two cases (45 years and 25 years old males) of Osmotic demyelination syndrome are described, to demonstrate the characteristic magnetic resonance imaging findings of the brain. Both cases were chronic alcoholics with a history of few episodes of vomiting, who later developed neurological symptoms. Their biochemical investigations showed severe hyponatremia. The hyponatremia was corrected rapidly, following which they developed neurological symptoms. Non-contrast MRI brain was done for both patients, which showed abnormal hyperintense T2/Fluid-attenuated Inversion Recovery (FLAIR) signals in central Pons. Both cases showed variable, however characteristics findings of osmotic demyelination syndrome on MRI. Despite, multiple causative factors and clinical outcomes of Osmotic demyelination syndrome, MRI with its characteristic findings plays a key role in diagnosis.