MRI Findings in Osmotic Myelinolysis (original) (raw)
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Isolated extra pontine myelinolysis – a rare imaging appearance of osmotic demyelination syndrome
The Journal of Clinical and Scientific Research, 2014
Rapid correction of hyponatraemia leads to serious neurological complications, like osmotic demyelination syndrome (ODS). In ODS, magnetic resonance imaging (MRI) often reveals features of pontine myelinolysis, that may occur in isolation or may, sometimes be associated with extrapontine myelinolysis. Isolated extrapontine myelinolysis is rare. We report the case of a 53-year-old lady brought to the emergency service with vomitings, and altered sensorium. She was found to have profound hyponatraemia (serum sodium 110 meq/L). Correction of hyponatremia was done with slow intravenous infusion of 3% sodium chloride. However, inadvertant, concomitant oral administration of salt led to overcorrection with serum sodium going upto 150 meq/L. She developed quadriplegia, depressed level of consciousness and respiratory failure and required ventilatory support. MRI brain showed features of isolated extrapontine myelinolysis.
Osmotic Demyelination Syndrome: Central Pontine Myelinolysis and Extrapontine Myelinolysis
Seminars in Ultrasound, CT and MRI, 2014
Osmotic demyelination syndrome (ODS) refers to central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM). These disorders are characterized by insults to regions of the brain with anatomical features predisposing white matter tracts to myelin injury in the setting of osmotic disturbances and their attempted correction. Occurring independently or in combination, CPM and EPM share a characteristic timing of onset, but distinct clinical features. Imaging features demonstrate characteristic findings that suggests ODS, but must be correlated
Cureus
Conventional magnetic resonance imaging (MRI) and computed tomography (CT) are used to diagnose central pontine myelinolysis (CPM), which is seen in the setting of osmotic changes, typically with the rapid correction of hyponatremia. However, they typically follow clinical symptoms and fail to detect myelinolytic lesions within the first two weeks, limiting their efficacy in early diagnosis. CPM can mimic brainstem ischaemic changes on CT head and a glioma on MRI. This case reviews the relationship between radiological changes seen with clinical symptoms and serum sodium levels, combined with reviewing pioneering advances in radiomic analysis, including diffusion-weighted MRI, CT brain perfusion and MR spectroscopy.
Early Detection of Central Pontine Myelinolysis with MRI: A Case Study
Central pontine myelinolysis (CPM) is a complication of treatment of patients with severe hyponatremia. The microscopic appearance of central pontine myelinolysis is loss of myelin with sparing of axons, without evidence of inflammation. The abnormalities associated with central pontine myelinolysis are readily identified on magnetic resonance imaging scans. A patient with central pontine myelinolysis following rapid correction of hyponatremia was studied with magnetic resonance imaging soon after onset of tetraplegia & dysarthria. Affected central pontine white matter showed restricted diffusion on diffusion-weighted images associated with hyper signal on T2-W & FLAIR images. MRI with dedicated sequences is the modality of choice for early detection of osmotic changes in the brain.
Central pontine and extrapontine myelinolysis: The osmotic demyelination syndromes
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2004
Central pontine myelinolysis is a demyelinating disorder characterized by the loss of myelin in the center of the basis pontis usually caused by rapid correction of chronic hyponatremia. The clinical features vary depending on the extent of involvement. Demyelination can occur outside the pons as well and diagnosis can be challenging if both pontine and extrapontine areas are involved. We herein report a case of myelinolysis involving pons, lateral geniculate bodies, subependymal region, and spinal cord. To the best of our knowledge, this case represents the second case of spinal cord involvement in osmotic demyelination syndrome and the first case of involvement of thoracic region of spinal cord.
MR imaging of seven presumed cases of central pontine and extrapontine myelinolysis
Acta neurobiologiae experimentalis, 2001
MRI was performed in seven patients with presumed central pontine and extrapontine myelinolysis. The underlying diseases were diabetes, lung cancer, Wilson disease, trauma, alcoholism, renal insufficiency and hemodialysis. CPM was found in four cases (in two of them extrapontine lesions were considered as resulting from Wilson disease), CPM and EPM in three patients. The localization of extrapontine changes included cerebellum, cerebral peduncles, caudate and lentiform nuclei, internal capsules, white matter and cortex of the cerebrum.
The Neuroradiology Journal, 2008
Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are disorďers frequently associated with seťum osmotic imbalance. The prognosis is very variable from complete regression of clinical symptomatology to signs of significant quadruparesis, a vegetative state and death. We report the case of a Z1-year-old man wíth a diagnosis of osmotic demyelination synďrome. The patient was young hea}thy man with no history of chronic alcoholism or malnutrition. He underwent head trauma associated with consumption of alcohol, being diagnosed with cerebral commotion. Four days later he presented with generalised epileptic convulsions with unconsciousness. Laboratory findings showed significant hyponatremia and hypochlorinemia. Following the rapid correction of osmotic conditions of serum, spastic quadruparesis and coma developed. MRI of the brain showed finding of CPM and EPM, cortical laminar necrosis (CLN) and coagulative necrosis in the putamina. Our case is suggestive in the rare MRI appearance of myelinolysis in addition to CLN and coagulative necrosis in the basal ganglia following the rapid correction of serum osmolarity. We suggest that this finding is prognostical}y very unfavourable. In the reported patient clinically initial neurological deficit progressed to a vegetative state within one month.
Myelin water imaging in multiple sclerosis: quantitative correlations with histopathology
Multiple Sclerosis, 2006
Various magnetic resonance (MR) techniques are used to study the pathological evolution of demyelinating diseases, such as multiple sclerosis (MS). However, few studies have validated MR derived measurements with histopathology. Here, we determine the correlation of myelin water imaging, an MR measure of myelin content, with quantitative histopathologic measures of myelin density. The multi-component T 2 distribution of water was determined from 25 formalin-fixed MS brain samples using a multi-echo T 2 relaxation MR experiment. The myelin water fraction (MWF), defined as T 2 signal below 30 milliseconds divided by the total signal, was determined for various regions of interest and compared to Luxol fast blue (myelin stain) mean optical density (OD) for each sample. MWF had a strong correlation with myelin stain [mean (range) R 2 0/0.67 (0.45 Á 0.92)], validating MWF as a measure of myelin density. This quantitative technique has many practical applications for the in vivo monitoring of demyelination and remyelination in a variety of disorders of myelin. Multiple Sclerosis 2006; 12: 747 Á 753.
Multiple Sclerosis Journal, 2011
Background: The pathological basis of diffusely abnormal white matter (DAWM) in multiple sclerosis (MS) has not been elucidated in detail, but may be an important element in disability and clinical progression. Methods: Fifty-three subjects with MS were examined with T 1 , multi-echo T 2 and magnetization transfer (MT). Twentythree samples of formalin-fixed MS brain tissue were examined with multi-echo T 2 and subsequently stained for myelin phospholipids using luxol fast blue, for axons using Bielschowsky, immunohistochemically for the myelin proteins myelin basic protein (MBP) and 2 0 ,3 0 -cyclic nucleotide 3 0 phosphohydrolase (CNP) and for astrocytes using glial fibrillary acidic protein (GFAP). Regions of interest in DAWM were compared with normal appearing white matter. Results: Fourteen of 53 subjects with MS in the in vivo study showed the presence of DAWM. Subjects with DAWM were found to have a significantly lower Expanded Disability Status Scale (EDSS) and shorter disease duration (DD) when compared with subjects without DAWM (EDSS: 1.5 versus 3.0, p ¼ 0.031; DD: 5.4 versus 10.3 years, p ¼ 0.045). DAWM in vivo had reduced myelin water and MT ratio, and increased T 2 and water content. Histological analysis suggests DAWM, which shows a reduction of the myelin water fraction, is characterized by selective reduction of myelin phospholipids, but with a relative preservation of myelin proteins and axons. Conclusions: These findings suggest that the primary abnormality in DAWM is a reduction or perturbation of myelin phospholipids that correlates with a reduction of the myelin water fraction.