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Osmotic demyelination syndrome: reversible MRI findings in bilateral cortical lesions
Yo-ichi Takei1, Chiho Akahane, Shu-ichi Ikeda
1Third Department of Medicine, Shinshu University School of Medicine, Asahi, Matsumoto.
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 T1-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.
Insights
Osmotic demyelination syndrome (ODS) can cause severe neurological symptoms. FLAIR MRI is crucial for detecting ODS lesions, which may resolve with corticosteroid treatment.
Area of Science:
- Neurology
- Radiology
- Internal Medicine
Background:
- Osmotic demyelination syndrome (ODS) is a rare neurological condition.
- It can result from rapid correction of hyponatremia.
- ODS can lead to significant neurological deficits.
Observation:
- A 70-year-old male presented with ODS symptoms including dyspnea, pseudobulbar palsy, and motor weakness.
- Acute-stage MRI revealed high-signal lesions in the pons, thalamus, and bilateral cortical areas on T1-weighted and FLAIR images.
- The patient received corticosteroid therapy.
Findings:
- Corticosteroid treatment led to recovery from dyspnea and pseudobulbar palsy.
- Spastic quadriplegia gradually improved.
- Brain lesions visualized on T1-, T2-weighted, and FLAIR images resolved one year post-treatment.
Implications:
- FLAIR imaging is essential for routine detection of cortical and subcortical lesions in ODS.
- Early diagnosis and treatment may improve patient outcomes.
- This case highlights the potential for lesion resolution in ODS with appropriate therapy.
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