Resolving MR features in osmotic myelinolysis (central pontine and extrapontine myelinolysis)

Osmotic myelinolysis is a distinctive clinical syndrome with characteristic MR features in the central pons (central pontine myelinolysis) and in other locations (extrapontine myelinolysis). We describe the resolving MR features in an adolescent who has experienced complete neurologic recovery. Regions of involvement manifested increased T2 signal intensity. The extrapontine involvement was noted to resolve earlier with interim-increased T1-weighted signal. The mechanism for the variable appearance of increased T1 signal intensity is discussed.