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Extrapontine myelinolysis and rhabdomyolysis (brain MRI and FLAIR)

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],

Associated Disorders

  • Alcoholism
  • Extrapontine myelinolysis
  • Hyperosmolar hyperglycemic state
  • Hypokalemia
  • Malnutrition
  • Osmotic myelinolysis