FDG PET/CT with SPM analysis in early diagnosis of clinically suspected osmotic demyelination syndrome with non-contributory MRI

Seniaray, Nikhil; Verma, Ritu; Ranjan, Rajeev; Belho, Ethel Shangne; Malik, Dharmender; Gupta, Vanshika; Jaimini, Abhinav; Mahajan, Harsh

doi:10.4103/ijnm.ijnm_95_19

Cited by 3 publications

(5 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the acute phase FDG‐PET shows hypermetabolism in the pons and basal ganglia and later shows hypometabolism. In a recent case report FDG‐PET was used to make a diagnosis of ODS in a patient whose MRI was negative 25 . In one of our patients who had delayed onset of dystonia, FDG‐PET was done which showed absent uptake in pons and mild reduced uptake in bilateral striatum and motor cortex suggestive of sequelae of ODS.…”

Section: Discussionmentioning

confidence: 90%

The Spectrum of Movement Disorders in Cases with Osmotic Demyelination Syndrome

Sindhu

Holla

Prasad

et al. 2021

Movement Disord Clin Pract

View full text Add to dashboard Cite

Background Osmotic demyelination syndrome (ODS) can be a central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) based on the regions involved even though they share the same disease process, aetiopathogenesis and time course. Objectives Present study aims to characterize the clinical, radiological features and the outcome of patients with ODS with movement disorders as the forthcoming manifestation. Methods Chart review of patients with ODS with movement disorders. Demographic, clinical and radiological details of the patients were reviewed. Results Eleven patients (six females; mean age: 48.3 ± 17.6 years) were included in the study. Parkinsonism alone and parkinsonism with dystonia was noted in four patients each (36.4%) while dystonia alone was noted in the other 3 (27.3%). Five patients (45.5%) had postural tremors. While 5 patients had dystonia early in the course of illness (3–7 days), it was delayed (6–9 months) in the other 2. A triphasic course was noted in two patients. The first phase of hyponatremia induced neurological impairment was followed by a second phase of worsening due to the immediate effect of ODS and a third delayed phase of worsening due to delayed effect of ODS. MRI showed both EPM and CPM in eight patients, EPM alone in two patients and CPM alone in 1 patient. Nine patients had a good outcome with mRS < 3. Conclusion Parkinsonism and dystonia are important manifestations of ODS. Triphasic course with a delayed phase of worsening of movement disorders is probably due to the maladaptive neuronal repair. The concept of triphasic ODS is first being described in our series.

show abstract

Section: Discussionmentioning

confidence: 90%

The Spectrum of Movement Disorders in Cases with Osmotic Demyelination Syndrome

Sindhu

Holla

Prasad

et al. 2021

Movement Disord Clin Pract

View full text Add to dashboard Cite

show abstract

“…Several cases in the literature of FDG PET done in the acute phase of osmotic demyelination syndrome before treatment describe metabolic abnormalities, such as white matter hypermetabolism and gray matter hypometabolism. The increased metabolism of activated microglia and astrocytes accumulated at the site of myelinolysis is responsible for FDG hypermetabolism [8][9][10]. Osmotic demyelination syndrome damage in white matter tracts interrupt neuronal network and lead to disconnection between gray matter regions 11,12.…”

mentioning

confidence: 99%

“…The increased metabolism of activated microglia and astrocytes accumulated at the site of myelinolysis is responsible for FDG hypermetabolism. [8][9][10] Osmotic demyelination syndrome damage in white matter tracts interrupt neuronal network and lead to disconnection between gray matter regions. 11,12 In our case, the right hippocampus disconnection was transient (B and C), and the patient recovered after thiamine treatment (D, white arrow).…”

mentioning

confidence: 99%

Sequential Brain Perfusion Findings in a Case of Osmotic Demyelination Syndrome

Ghomari

Misgault²,

Diallo³

et al. 2022

Clin Nucl Med

View full text Add to dashboard Cite

A 60-year-old man with chronic alcoholism for 30 years was admitted to the hospital for an acute alcoholic syndrome with global confusional state, cognitive disorders, and ataxia. MRI detected bilateral mamillary bodies T 2 hypersignal related to Wernicke encephalopathy. It was treated by oral thiamine supplementation with clinical improvement. Two months later, he was rehospitalized for rapidly progressive dementia symptoms. Brain perfusion scintigraphy revealed pontine hyperperfusion and right hippocampal hypoperfusion. One month after IV thiamine supplementation, brain perfusion scintigraphy showed normalization of perfusion abnormalities in the pons and right hippocampus, leading to the diagnosis of alcoholic-related osmotic demyelination syndrome.

show abstract

“…However, there are only 3 case reports describing FDG PET/CT findings. [7][8][9][10][11] The knowledge of this rare clinical entity and its imaging findings is important and helps a physician to avoid misinterpretation.…”

mentioning

confidence: 99%

“…There are various case reports and review articles on CPM describing clinical presentation, CT, and MRI scan findings. However, there are only 3 case reports describing FDG PET/CT findings 7–11 . The knowledge of this rare clinical entity and its imaging findings is important and helps a physician to avoid misinterpretation.…”

mentioning

confidence: 99%