Value of diffusion-weighted imaging in central pontine and extrapontine myelinolysis

Förster, Alex; Nölte, I.; Wenz, Holger; Al-Zghloul, Mansour; Kerl, H; Brockmann, Carolin; Brockmann, Marc A.; Groden, Christoph

doi:10.1007/s00234-012-1083-z

Cited by 31 publications

(37 citation statements)

References 23 publications

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“…In this case, brain MRI images corresponded with typical radiological findings of CPM and extrapontine lesions were showed the same results. One study reported that early DWI changes are a common finding in ODS but do not regularly precede the tissue changes that are detectable on conventional MRI sequences [2]. With these radiologic findings, neurologic examinations, laboratory findings, and past history, we finally diagnosed ODS and could differentiate from other possible diseases.…”

Section: Discussionmentioning

confidence: 85%

“…CPM is classically described as the radiological manifestations of osmotic myelinolysis, and clinical symptoms range from subtle changes in cognitive functions to life-threatening autonomic and brainstem dysfunction and death [1]. EPM develops in extrapontine sites through mechanisms similar to CPM but the cases of EPM have been reported rarely than those of CPM [1,2].…”

Section: Introductionmentioning

confidence: 99%

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Central and Extrapontine Myelinolysis after Alcohol Withdrawal and Correction of Hypernatremia in a Chronic Alcoholic: a Case Report

2017

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Highlights• Osmotic myelinolysis rarely occurs with the correction of hypernatremia.• Alcohol withdrawal with hypernatremia can result in osmotic myelinolysis.• Careful electrolyte correction is needed after alcohol withdrawal. ABSTRACTOsmotic demyelination syndrome (ODS) is a demyelinating disorder related to the rapid correction of hyponatremia. It usually affects the pontine area; hence, the name central pontine myelinolysis (CPM). However, it rarely occurs with the correction of hypernatremia and hyperosmolarity and involves extrapontine areas. A 56-year-old chronic alcoholic had been admitted with a history of confusion. He had been in alcohol withdrawal for 4 days. Laboratory examinations showed severe hypernatremia and hyperosmolarity. After serum sodium level was normalized; however, his clinical course did not improve and deteriorated to semicoma progressively. Magnetic resonance imaging (MRI) revealed abnormal signal intensity in the pontine and extrapontine areas, including the basal ganglia, thalamus, and cerebral cortices. This is the first case report of combined central pontine and extrapontine demyelination after alcohol withdrawal and correction of hypernatremia in a chronic alcoholic.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Central and Extrapontine Myelinolysis after Alcohol Withdrawal and Correction of Hypernatremia in a Chronic Alcoholic: a Case Report

2017

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“…Osmotic myelinolysis classically occurs in the setting of rapidly corrected severe hyponatremia of several days duration [94]. Conditions associated with osmotic myelinolysis include alcoholism, alcohol withdrawal, malnutrition, liver transplantation, cirrhosis and severe burns [95]. Prognosis is quite variable, with approximately one-third of patients recovering completely, onethird having mild residual neurologic deficits and one-third remaining severely neurologically impaired [96].…”

Section: Osmotic Myelinolysismentioning

confidence: 99%

“…In some studies, diffusion abnormalities were seen days to weeks before abnormalities appeared on conventional MRI sequences [98]. Over the course of weeks, the diffusion abnormalities may completely resolve or demonstrate T 2 shine-through [95,98,99]. Resolution of diffusion abnormalities may predict a better prognosis for the patient [99], although this is controversial [96].…”

Section: Osmotic Myelinolysismentioning

confidence: 99%

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“Dazed and diffused”: making sense of diffusion abnormalities in neurologic pathologies

O’Connor

Barest²,

Moritani³

et al. 2013

BJR

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To review diffusion abnormalities seen in diffusion-weighted MRI in neurological pathologies. We examine the clinical significance of the abnormalities in a broad spectrum of neurological diseases and highlight our current understanding of their causes. Diffusion abnormalities seen on diffusion-weighted MRI can play an important role in the diagnosis and follow-up of a broad spectrum of neurological diseases. A thorough understanding of the appearance and significance of these abnormalities is critical in patient management.Although the best known use of diffusion-weighted imaging (DWI) in MRI of the brain is detection of acute vaso-occlusive infarct, diffusion abnormalities occur in a wide spectrum of neurological pathologies. These diffusion abnormalities provide information that can directly affect the management of a patient, whether identifying pathology that would otherwise go unrecognised, narrowing a broad differential diagnosis, identifying conditions that require emergent intervention, evaluating response to treatment or providing prognostic information about a patient's expected clinical course. In this review, we explain the significance of diffusion abnormalities in a variety of neurological diseases and highlight our current understanding of the causes of these diffusion abnormalities.

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Clinical Applications of Diffusion

Márquez

Sananmuang

Srinivasan

et al. 2023

Functional Neuroradiology

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Value of diffusion-weighted imaging in central pontine and extrapontine myelinolysis

Abstract: We conclude that early DWI changes are a common finding in CPM/EPM but do not regularly precede tissue changes detectable on conventional MRI sequences. Heterogenous ADC values possibly represent different stages of disease.

Cited by 31 publications

References 23 publications

Central and Extrapontine Myelinolysis after Alcohol Withdrawal and Correction of Hypernatremia in a Chronic Alcoholic: a Case Report

Central and Extrapontine Myelinolysis after Alcohol Withdrawal and Correction of Hypernatremia in a Chronic Alcoholic: a Case Report

“Dazed and diffused”: making sense of diffusion abnormalities in neurologic pathologies

Clinical Applications of Diffusion

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