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Extrapontine myelinolysis and rhabdomyolysis (brain MRI and FLAIR)

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Axial T2 images (a, b) show abnormal hyperintense signal involving the middle cerebellar peduncles, splenium of the corpus callosum, and posterior limb of the internal capsule. The coronal fluid-attenuated inversion recovery (FLAIR) image (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 susceptibility-weighted images (f). The imaging features are characteristic of hypernatremic encephalopathy with osmotic myelinolysis and rhabdomyolysis. (Source: Choudhary G, Qureshi F, Arora A, Kothari N, Tiwari S, Bhatia P. Postpartum hypernatremia with extrapontine rhabdomyelinolysis: a case report. Qatar Med J 2022;2022[4]:45. Creative Commons Attribution license [CC BY], https://creativecommons.org/licenses/by/4.0.)