Central pontine myelinolysis (MR).

MRI BRAIN & ANGIOGRAPHY


PROTOCOL:
T2W – Sagittal & axial scans
T1W – Axial scans
FLAIR – Coronal scans
DW & T2FFE (Gradient) – Axial scans
3D TOF MR angiography of the circle of Willis vessels and MIP reconstruction.

FINDINGS:

-Evidence of a lesion is noted in the central part of the pons with butterfly appearance with its middle part in the center and extending on both sides. It was shown as area of hypo intensity on MR images and hyper intensity on T2-weighted images in the central pons with sparing of the pontine tegmentum and ventrolateral pons.
-On diffusion images no restricted diffusion could be elicited while in ADC maps images revealed free diffusion.
-There is evidence of multiple, variable sized small foci of altered signal were noted on both sides of peri ventricular and centrum semi ovale regions.
-Partial empty sella syndrome.

-Lateral and third ventricles are normal in size and position. Septum is in midline.  There is no midline shift.
-Basal cisterns, cortical sulci and gyri are normal in appearance.
-Corpus callosum shows normal MR morphology.
-Cerebellum show normal signal intensities.
-Fourth ventricle is normal in size and is midline in position.
-MR angiography reveals normal course, caliber and outlines of vessels of bilateral CA, ACA, MCA, PCA and their peripheral branches. Vertebro basilar trunk is also normal in appearance.

OPINION:

• Regarding the findings mentioned in the diffusion and ADC maps images and the sparing of pontine tegmentum and ventrolateral pons; the pontine lesion gives impression of central pontine myelinolysis rather than central pontine infarction for clinical correlation.
• Grade I (Fazekas classification) small vessel ischemic disease of the brain.
• Partial empty sella syndrome.


Reported By : DR.MOHAMMED MOHYELDIN
 Consultant-Radiologist
Report Status : Validated / Validated By :  Dr.Mohammed Mohyeldin