Images in Clinical Medicine

Kim Eagle, M.D., Editor

Osmotic Myelinolysis

Blaine L. Hart, M.D., and R. Philip Eaton, M.D.

N Engl J Med 1995; 333:1259November 9, 1995

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Article

Figure 1 A 30-year-old alcoholic woman presented with confusion and disorientation after a grand mal seizure. The patient's serum sodium concentration on admission was 99 mmol per liter. Treatment was initiated with a slow infusion of normal saline, resulting in serum sodium values of 102 mmol per liter 4 hours after admission, 104 mmol per liter at 8 hours, 115 mmol per liter at 12 hours, 118 mmol per liter at 18 hours, and 125 mmol per liter at 24 hours. The patient initially had dysarthria, with slurred speech, and a slow finger-to-nose test on cerebellar examination, although there was no Babinski reflex. During days 2 to 6 with a normal serum sodium concentration, her condition gradually improved, although she interacted slowly with staff members and family, and had difficulty following commands. On the seventh day she became unresponsive to commands and painful stimuli and had a Babinski reflex. Magnetic resonance imaging demonstrated central pontine myelinolysis as a region of prominent low signal intensity on a sagittal T₁-weighted image (Panel A, arrowheads) and high signal intensity on an axial T₂-weighted image (Panel B, arrows). The signal intensity on the periphery of the pons is normal on both images, and there is relative preservation of the corticospinal tracts (Panel B, arrowheads). The patient remained in an unresponsive state for seven weeks, but her sensorium gradually improved until she was fully responsive, alert, and oriented.

Kim Eagle, M.D.

Blaine L. Hart, M.D.
R. Philip Eaton, M.D.
University of New Mexico School of Medicine, Albuquerque, NM 87131

Citing Articles (2)

Citing Articles

1. 1

   Shih-Hua Lin, Tom Chau, Chia-Chao Wu, Sung-Sen Yang. (2002) Osmotic Demyelination Syndrome after Correction of Chronic Hyponatremia with Normal Saline. The American Journal of the Medical Sciences 323:5, 259-262
   CrossRef

2. 2

   Edith V. Sullivan, Adolf Pfefferbaum. (2001) Magnetic Resonance Relaxometry Reveals Central Pontine Abnormalities in Clinically Asymptomatic Alcoholic Men. Alcoholism: Clinical and Experimental Research 25:8, 1206-1212
   CrossRef