- Occurs if hyponatremia is rapidly corrected
- This destroys blood-brain barrier, causes hypertonic fluid accumulation in extracellular space, causes non-inflammatory demyelination, affecting mainly pons
- Paralysis, dysphagia, dysarthria, pseudobulbar palsy
- Death frequent
Imaging
- MRI
- High T2 signal in central pons, with symmetrical trident pattern sparing periphery and corticospinal tracts
- Hypointense on T1
- Peripheral contrast enhancement
- Restricted diffusivity
- If patient survives, chronic lesions appear as a cavitation
- Extrapontine sites of involvement: cerebellum and lateral genicular body, less common in thalamus, subcortical white matter and basal ganglia
Read more
Howard, Stephanie A., et al. “Osmotic demyelination syndrome.” Radiographics 29.3 (2009): 933-938.