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Normal diffusion-weighted MRI during the acute stage of central pontine myelinolysis
Suk Yun Kang1, Hyeo-Il Ma, Young-Min Lim
1Department of Neurology, Hallym University College of Medicine, Seoul, Republic of Korea. sukyunkang@hanmail.net
Abstract:
Central pontine myelinolysis (CPM) is rare demyelinating disorder characterized by loss of myelin in the center of the basis pontis. The clinical features of CPM vary depending on the involved areas. Diffusion-weighted imaging (DWI) is thought to be useful for early detection during the acute phase, but its utility in this context has not been investigated thoroughly. We report the case of a CPM patient with normal initial DWI findings even at 1 week after symptom onset. To the best of our knowledge, no such cases of CPM have previously been reported.
Insights
Central pontine myelinolysis (CPM) is a rare demyelinating disorder. This case highlights that initial diffusion-weighted imaging (DWI) may appear normal in CPM patients even one week after symptom onset.
Area of Science:
- Neurology
- Neuroimaging
- Demyelinating Diseases
Background:
- Central pontine myelinolysis (CPM) is a rare neurological disorder.
- It involves myelin loss in the basis pontis, leading to varied clinical presentations.
- Early detection is crucial for management, with diffusion-weighted imaging (DWI) considered a key diagnostic tool.
Observation:
- This report details a case of CPM in a patient presenting with initially normal DWI findings.
- These normal findings persisted even one week after the onset of clinical symptoms.
- This observation is significant as it contrasts with the expected sensitivity of DWI in acute demyelinating lesions.
Findings:
- The study identifies a potential limitation of DWI in the early diagnosis of CPM.
- It suggests that a normal DWI in the acute phase does not definitively rule out CPM.
- This is the first reported case of CPM with normal initial DWI findings up to one week post-symptom onset.
Implications:
- The findings necessitate a re-evaluation of the diagnostic utility of DWI in early CPM.
- Clinicians should consider alternative diagnostic approaches or serial imaging if CPM is suspected despite normal initial DWI.
- This case contributes to a better understanding of CPM's imaging characteristics and diagnostic challenges.
