J Korean Soc Radiol.  2020 Jan;81(1):243-247. 10.3348/jksr.2020.81.1.243.

Serial Magnetic Resonance Imaging Findings in Hyperglycemia-Related Osmotic Demyelination Syndrome: A Case Report

• Kim JH
• Park NH
• Park JY
• Kim SJ

• KMID: 2469201
• DOI: http://doi.org/10.3348/jksr.2020.81.1.243

Abstract

We report a rare case of hyperglycemia-related osmotic demyelination syndrome (ODS) with focus on the imaging findings. A 61-year-old man with diabetes was admitted for general weakness and severe thirst. A few days later, he complained of dysarthria, dysphasia, and dysmetria. Laboratory examinations showed significant hyperglycemia, but normal electrolyte levels. Brain MRI revealed T2-signal abnormalities that were symmetrical, non-space occupying, and located in the central pons with a peripheral sparing pattern, which were suggestive of ODS. In addition, subsequent MRI revealed progression of signal hyperintensity; however, the patient's symptoms improved.

MeSH Terms

Aphasia
Brain
Cerebellar Ataxia
Demyelinating Diseases*
Dysarthria
Humans
Hyperglycemia
Magnetic Resonance Imaging*
Middle Aged
Pons
Thirst

Figure

• 

  Fig. 1 Serial MR findings of hyperglycemia-related osmotic demyelination syndrome in a 61-year-old man. A. Axial FLAIR and T2WI at the level of the pons reveal bilaterally symmetric high signal intensity in the central pons with sparing of the outer rim. B. DWI and ADC map at the level of the pons reveal signal abnormalities in the affected region. On the ADC map, there is no signal dropout in the region of hyperintensity, which is consistent with T2 shine-through. C. Follow-up MRI 10 days later. Axial FLAIR MRI at the level of the upper (left) and lower pons (right) reveal newly developed high signal intensity in the posterior tegmentum area (white arrow) and bilateral brachium pontis (black arrows). D. Follow-up MRI 1 month later. Axial FLAIR MRI at the level of the upper pons demonstrates no newly developed lesions; however, the previously detected signal abnormalities have become more conspicuous and confluent. ADC = apparent diffusion coefficient, DWI = diffusion-weighted imaging, FLAIR = fluid-attenuated inversion recovery, T2WI = T2-weighted image

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