Central Pontine Myelinolysis and Localized Fluorodeoxyglucose Uptake Seen on ¹⁸F-FDG PET/CT

Area of Science:

• Neurology
• Radiology
• Nuclear Medicine

Background:

• Central pontine myelinolysis (CPM) is a neurological condition characterized by demyelination in the pons.
• It often presents with significant motor and cognitive deficits.
• Rapid correction of hyponatremia is a known risk factor for CPM development.

Observation:

• A case report of a patient with a history of alcoholism undergoing treatment for hyponatremia.
• The patient experienced a marked decline in motor and cognitive functions.
• Combined fluorine-18 (18F)-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed.

Findings:

• Combined 18F-FDG PET/CT demonstrated localized FDG uptake within the pons.
• This finding was consistent with central pontine myelinolysis (CPM) identified on magnetic resonance imaging (MRI).
• The study suggests that metabolic activity in activated glial cells and macrophages may contribute to the observed FDG uptake in active CPM lesions.

Implications:

• This report highlights the utility of 18F-FDG PET/CT in diagnosing CPM, particularly in conjunction with MRI.
• Understanding the metabolic processes in CPM may lead to novel diagnostic or therapeutic strategies.
• The findings support the hypothesis that osmotic stress-induced blood-brain barrier disruption plays a role in CPM pathogenesis.