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Osmotic Demyelination Syndrome in End-Stage Renal Disease After Recent Hemodialysis: MRI of the Brain

N. Cagla Tarhan1, A. Muhtesem Agildere1, U. Sibel Benli2, F. Nurhan Ozdemir2, Cuneyt Aytekin1 and Ufuk Can2

1 Department of Radiology, Baskent University Faculty of Medicine, Fevzi Cakmak Cad. 10. Sok No. 45, 06490 Bahçelievler, Ankara, Turkey.
2 Department of Nephrology, Baskent University Faculty of Medicine, Ankara, Turkey.



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  		Fig. 1A. —52-year-old woman with pontine osmotic demyelination syndrome. Axial T2-weighted image (TR/TE, 4,000/99; slice thickness, 6 mm; acquisitions, 3; matrix, 154 x 256) shows edema in central pons (arrows) and preservation of tegmentum and ventrolateral aspects of pons.

 


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  		Fig. 1B. —52-year-old woman with pontine osmotic demyelination syndrome. On follow-up MR image, edema has completely resolved.

 


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  		Fig. 2A. —33-year-old man with pontine osmotic demyelination syndrome. Edema in posterior part of pons bilaterally (arrow) is seen as hypointense on axial T1-weighted image (TR/TE, 500/15; slice thickness, 6 mm; acquisitions, 3; matrix, 144 x 256).

 


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  		Fig. 2B. —33-year-old man with pontine osmotic demyelination syndrome. Edema is also seen on axial T2-weighted image (4,000/99; matrix, 154 x 256, acquisitions, 3).

 


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  		Fig. 2C. —33-year-old man with pontine osmotic demyelination syndrome. MR image repeated after 3 weeks shows that lesion has completely resolved. Persistent area of hyperintensity in right ventral aspect of pons was thought to be consistent with ischemic gliosis (arrow).

 


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  		Fig. 3A. —52-year-old man with extrapontine osmotic demyelination syndrome. Bilateral asymmetric areas of increased intensity are seen in basal ganglia on axial FLAIR image. Lesions on right are more prominent.

 


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  		Fig. 3B. —52-year-old man with extrapontine osmotic demyelination syndrome. Follow-up MR image after 40 days shows that lesions in anterior part of right putamen, posteromedial portion of left putamen, and left caudate nucleus have resolved. Persistent edema remains in some parts of bilateral putamina.

 


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  		Fig. 4A. —19-year-old woman with extrapontine osmotic demyelination syndrome. Bilateral symmetric areas of edema in periventricular white matter and centrum semiovale are detected on axial FLAIR image.

 


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  		Fig. 4B. —19-year-old woman with extrapontine osmotic demyelination syndrome. Same lesions are shown on T2-weighted coronal image.

 


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  		Fig. 5A. —36-year-old woman with pontine and extrapontine osmotic demyelination syndrome. Bilateral areas of increased intensity are seen in pons, mesencephalon, and periventricular white matter on T2-weighted coronal image.

 


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  		Fig. 5B. —36-year-old woman with pontine and extrapontine osmotic demyelination syndrome. Bilateral symmetric areas of increased intensity are seen in posterior limb of internal capsule on T2-weighted axial image.

 


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  		Fig. 5C. —36-year-old woman with pontine and extrapontine osmotic demyelination syndrome. Follow-up T2-weighted coronal MR image after 2 weeks reveals complete resolution of lesions, with new area of focal hyperintensity in ventral aspect of right putamen (arrow). This one-sided persistent lesion was interpreted as infarct, not extrapontine osmotic demyelination syndrome.

 

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