J Korean Soc Radiol.  2014 Nov;71(5):201-204. 10.3348/jksr.2014.71.5.201.

Osmotic Demyelination Syndrome with Recent Chemotherapy in Normonatremic Patient: A Case Report

• Lee S
• Baek HJ
• Jung HK
• Kim SJ
• Lee Y
• Lee K
• Ryu JH
• Kim HD

• KMID: 2208789
• DOI: http://doi.org/10.3348/jksr.2014.71.5.201

Abstract

Osmotic demyelination syndrome (ODS), an acquired demyelinating condition of the central pons and/or other regions of the brain, is frequently associated with rapid correction of hyponatremia. There are several reports of ODS in other clinical setting such as malnutrition, alcoholism, transplantation, malignancy, and chronic debilitating illness. However, cases of ODS associated with chemotherapy have not been frequently reported. Here, we describe a case of ODS in a normonatremic patient recently underwent chemotherapy for colon cancer. The diagnosis was confirmed by MRI showing a typical T2 hyperintensity in the central pons. This case suggests that ODS is not always associated with hyponatremia and that ODS can have a favorable clinical and radiologic prognosis.

MeSH Terms

Alcoholism
Brain
Colonic Neoplasms
Demyelinating Diseases*
Diagnosis
Drug Therapy*
Humans
Hyponatremia
Magnetic Resonance Imaging
Malnutrition
Myelinolysis, Central Pontine
Pons
Prognosis

Figure

• 

  Fig. 1 A 66-year-old man presented with a 1 month history of intermittent headache. A, B. Axial T2-weighted (A) and fluid-attenuated inversion recovery (FLAIR) (B) MR images reveal a hyperintense lesion in the central pons without mass effect (arrows). C, D. Axial T1-weighted MR image (C) demonstrates T1 hypointensity in the central pons, and axial contrast enhanced T1-weighted MR image (D) shows no definite enhancement of the lesion (arrows). E, F. On follow-up MR imaging after 2 months, the central pontine lesion shows a complete resolution on axial T2-weighted (E) and FLAIR (F) images.

Reference

1. Adams RD, Victor M, Mancall EL. Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients. AMA Arch Neurol Psychiatry. 1959; 81:154–172.

2. Martin RJ. Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes. J Neurol Neurosurg Psychiatry. 2004; 75:Suppl 3. iii22–iii28.

3. Dolciotti C, Nuti A, Cipriani G, Borelli P, Baldacci F, Logi C, et al. Cerebellar ataxia with complete clinical recovery and resolution of MRI lesions related to central pontine myelinolysis: case report and literature review. Case Rep Neurol. 2010; 2:157–162.

4. King JD, Rosner MH. Osmotic demyelination syndrome. Am J Med Sci. 2010; 339:561–567.

5. Huq S, Wong M, Chan H, Crimmins D. Osmotic demyelination syndromes: central and extrapontine myelinolysis. J Clin Neurosci. 2007; 14:684–688.

6. Lupato A, Fazio P, Fainardi E, Cesnik E, Casetta I, Granieri E. A case of asymptomatic pontine myelinolysis. Neurol Sci. 2010; 31:361–364.

7. Cramer SC, Stegbauer KC, Schneider A, Mukai J, Maravilla KR. Decreased diffusion in central pontine myelinolysis. AJNR Am J Neuroradiol. 2001; 22:1476–1479.

8. Hurley RA, Filley CM, Taber KH. Central pontine myelinolysis: a metabolic disorder of myelin. J Neuropsychiatry Clin Neurosci. 2011; 23:369–374.

9. Yau TK, Yiu HY, Lee WM. Central pontine myelinolysis: report of two occurrences after cisplatin-containing chemotherapy for nasopharyngeal carcinoma. Clin Oncol (R Coll Radiol). 1993; 5:395–339.