Board Review 1 – Case 19

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

The initial CT in this patient shows subtle hyperintensity in the pons which could easily be mistaken for artifact. However, MRI confirms a central and symmetric hyperintensity within the pons.

The diagnosis is: osmotic demyelination

Osmotic demyelination is a diagnosis characterized by central FLAIR hyperintensities in the pons, although abnormalities can occur anywhere in the brain. They are associated with abnormalities in serum osmolality, particularly sodium concentration. The primary differential consideration is infarct, although these are rarely bilaterally symmetric.