PMC7125463_01
Correlation between sequence of events and serial laboratory results. Day 1 corresponds to the day of admission. Value units are the following: mg/dL for serum urea, creatinine, and glucose; mmol/L for serum sodium and potassium; g/dL for serum albumin.
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There were no electrolyte disturbances in blood analysis by the time the patient developed these symptoms (Figure 1).
MRI images show central pontine T1 moderately hypointense areas (a), T2 and FLAIR areas of hyperintensity at the level of the pons (b, c, d, f), including an area trident-shaped of hyperintensity at the level of the pons on axial T2 (b) (typical appearances of the pons in osmotic demyelination syndrome), that extends to cerebellar peduncles (b, e); after gadolinium, there was no enhancement (g).
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MRI was then performed revealing heterogeneous T1-hypointense, T2-hyperintense, and FLAIR-hyperintense areas located in the pons, cerebellar peduncles (mainly in the middle cerebellar peduncles), which were compatible with ODS (Figure 2). MRI also showed millimetric lacunae infarcts in corona radiata bilaterally and left cerebellum.