Osmotic Demyelination Syndrome: Reversible MRI Findings in Bilateral Cortical Lesions

Abstract

A 70-year-old man who suffered from osmotic demyelination syndrome (ODS) is presented. Dyspnea, pseudobulbar palsy and motor weakness were seen. MRI in the acute stage revealed focal abnormal high-signal lesions in the pons, thalamus and bilateral cortical areas on Tl-weighted and FLAIR images. With corticosteroid therapy he recovered from his dyspnea and severe pseudobulbar palsy, and the spastic quadriplegia gradually improved. One year later the brain lesions had disappeared on T1-, T2-weighted and FLAIR images. To detect the cortical or subcortical lesions in ODS, FLAIR imaging should be performed routinely. (Internal Medicine 42: 867-870, 2003)

MRI findings of corticosubcortical lesions in osmotic myelinolysis: report of two cases

“…To our knowledge, seven cases with corticosubcortical lesions have been described in six reports that include MRI [4][5][6][7][8][9]. Reviewing those reports, we found that, consistent with Okeda's pathological classification, the two types of corticosubcortical OM lesions can also be discriminated on MRI.…”

“…Gocht et al [2] examined lesion distribution in 58 autopsy cases with OM and found cerebral corticosubcortical lesions in 15%. To the best of our knowledge, corticosubcortical lesions associated with OM have been unfamiliar clinically, and their imaging findings have been reported only sporadically [4][5][6][7][8][9]. Okeda et al [3] studied the pathological features of corticosubcortical lesions in autopsy cases with OM and reported two distinct subtypes of lesions: cortical and subcortical.…”

“…Reviewing those reports, we found that, consistent with Okeda's pathological classification, the two types of corticosubcortical OM lesions can also be discriminated on MRI. Involvement was cortical in four cases [5][6][7]9], subcortical in two cases [4,8] and mixed in one case [5].…”

“…In the literature, MRI findings of OM consist primarily of hyperintensity on T 2 weighted images (T 2 WI) or fluid-attenuated inversion-recovery (FLAIR) images in the central pons (central-pontine myelinolysis), midbrain, bilateral thalami and/or basal ganglia (extrapontine myelinolysis), or a combination of these [1]. Although cerebral corticosubcortical involvements have been described in pathological studies [1][2][3], a description of the MRI findings has been mostly limited to case reports [4][5][6][7][8].We report serial MRI findings in two patients with corticosubcortical lesions associated with OM. One patient's lesions were disclosed on MRI that included diffusion-weighted imaging (DWI) and T 1 weighted imaging (T 1 WI) with contrast enhancement that were obtained 8 days (late acute phase) and 26 days (subacute phase) after the onset of neurological symptoms.…”

Central Pontine and Extrapontine Myelinolysis in an Infant Associated With the Treatment of Craniopharyngioma -Case Report-

“…This pattern is thought to represent resolution of acute edema, remyelination, and decreased astrocytic response, based on the restoration of increased axonal membrane permeability, deleterious intracellular cascades, and disturbance of axonal transport. 3,5,8,11,14,16) The MR findings in osmotic demyelination syndrome are not specific with inconsistent appearance. 9) One case of osmotic demyelination syndrome had persistent computed tomography findings even after clinical improvement.…”