Osmotic demyelination syndrome: imaging features and differential diagnoses

Congress:

ECR 2020

Poster Number:

C-11883

Type:

Educational Exhibit

Keywords:

Not applicable, Pathology, Metabolic disorders, Imaging sequences, Diagnostic procedure, MR-Diffusion/Perfusion, MR, Neuroradiology brain, CNS, Neuro

Authors:

M. A. Maresca, N. Sverzellati; Parma/IT

DOI:

10.26044/ecr2020/C-11883

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-11883

Fig. 1: 38 years old woman with severe electrolytic alteration in alcohol abuse,...

Fig. 2: 38 years old woman with severe electrolytic alteration in alcohol abuse,...

Fig. 3: 23 years old woman affected by pilocytic astrocitoma with panhypopituitarism...

Fig. 4: 54 years old man with isolated pontine myelinolysis: trident shape lesion in...

Learning objectives

To describe the imaging features of Osmotic demyelination syndrome (ODS) and its major differential diagnoses.

Background

ODS is a complex pathologic entity characterized by osmotic myelinolysis due to osmolality disorders, that determines an acute onset of neurologic symptoms. ODS was formerly described as central pontine myelinolysis, since pons and brainstem are the most sensitive to osmotic stress. However, ODS refers to a more complex syndrome that can affect both pontine and extrapontine structures (50% of cases), or the isolated pons(30%). The occurrence of isolated extrapontine myelinolysis is the less common (20% of cases), which makes the diagnosis even more challenging, underscoring...

Findings and procedure details

Imaging CT of the brain often fails to show the early changes of central pontine myelinolysis because it results from subtle alteration in the tissue water content, which is further obscured by artifact occurring in this region of the brain; after the onset of symptoms there is a delay of one-two weeks for the detection of the lesions on CT images, with an appearance of hypoattenuating lesions. The lesions, under MR imaging mode, appear as areas of hyperintensity on T2-weighted images and FLAIR images, corresponding...

Conclusion

Though ODS is a rare pathologic entity, it can determine severe neurological damage and MRI is essential for an early diagnosis that ensures an appropriate management of the patient.

Personal information and conflict of interest

M. A. Maresca; Parma/IT - nothing to disclose N. Sverzellati; Parma/IT - nothing to disclose

References

Osborn AG, Gary L. Hedlund, DO Salzman KL, Osborn's Brain: Imaging, Pathology, and Anatomy (2° edition) Salt Lake City, UT : Elsevier, Inc., 2017. Asrar Ahmed et al., Osmotic myelinolysis (central pontine myelinolysis and extrapontine myelinolysis) Ann Saudi Med 2007. Garg P et al. Osmotic demyelination syndrome ‑evolution of extrapontine before pontine myelinolysis on magnetic resonance imaging. J Neurosci Rural Pract 2019. Sterns RH, Hix JK, Silver S (2010) Treatment of hyponatremia. CurrOpinNephrolHypertens 19: 493-498. Kumon et al., The Improvement of the Outcome of Osmotic...