PMC9577390_01
Non-contrast computed tomography of the head at the level of the basal ganglia (a) and centrum semiovale (b) does not show any obvious abnormalities.
qmj-2022-04-045.g001.jpg
PMC9577390_01_qmj-2022-04-045.g001.jpg
fig1
Her CT of the brain was normal (Figure 1), following which a cerebrospinal fluid (CSF) was sent for examination.
Change in serum sodium (mEq/L) over a few days (D).
qmj-2022-04-045.g002.jpg
PMC9577390_01_qmj-2022-04-045.g002.jpg
fig2
Serial monitoring of serum sodium was conducted using arterial blood gas analysis (Figure 2).
Axial tbl2 (a, b) images show abnormal hyperintense signal involving bilateral middle cerebellar peduncles, splenium of the corpus callosum, and posterior limb of the internal capsule. The coronal fluid-attenuated inversion recoveryimage (c) demonstrated selective involvement of the corticospinal tract (short arrows) giving a "wine-glass" appearance. The involved areas show restriction on diffusion-weighted images (d,e) with evidence of microhemorrhages on the susceptibility-weighted images (f). The imaging features are characteristic of hypernatremic encephalopathy with osmotic myelinolysis and rhabdomyolysis
qmj-2022-04-045-g003.jpg
PMC9577390_01_qmj-2022-04-045-g003.jpg
fig3
The imaging features were suggestive of postpartum hypernatremic encephalopathy with osmotic extrapontine myelinolysis (Figure 3).