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Decreased diffusion in central pontine myelinolysis
S C Cramer1, K C Stegbauer, A Schneider
1Department of Neurology, University of Washington, Seattle, WA 98195, USA.
Abstract:
Two patients with central pontine myelinolysis (CPM) were studied with diffusion-weighted MR imaging 1 week after onset of tetraplegia. In both patients, affected white matter showed hyperintensity on diffusion-weighted images associated with a decrease in apparent diffusion coefficient (ADC) values. In one patient studied serially, ADC values normalized by 3 weeks after tetraplegia. Early in the clinical course, diagnosis of CPM can sometimes be difficult. Hyperintensity on diffusion-weighted images may therefore have diagnostic utility. Decreased lesional ADC values support the notion that CPM is a consequence of relative intracellular hypotonicity.
Insights
Diffusion-weighted MRI can help diagnose central pontine myelinolysis (CPM) early. Affected white matter shows increased signal intensity and decreased apparent diffusion coefficient (ADC) values, supporting CPM
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Central pontine myelinolysis (CPM) diagnosis can be challenging in early stages.
- Diffusion-weighted magnetic resonance imaging (DW-MRI) is a key neuroimaging technique.
Observation:
- Two patients with CPM underwent DW-MRI one week after developing tetraplegia.
- Affected white matter in CPM lesions exhibited hyperintensity on DW-MRI.
- Apparent diffusion coefficient (ADC) values were decreased in these affected areas.
Findings:
- Hyperintensity on DW-MRI correlated with decreased ADC values in CPM lesions.
- In one patient, ADC values normalized within three weeks of symptom onset.
- These findings suggest CPM may result from relative intracellular hypotonicity.
Implications:
- DW-MRI holds diagnostic utility for early CPM detection.
- Reduced ADC values provide evidence for the osmotic theory of CPM pathogenesis.
- This neuroimaging approach can aid in understanding and managing CPM.
