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|Year : 2015 | Volume
| Issue : 6 | Page : 996
The owl and the monkey - The varied faces of pons in central pontine myelinolysis
Sanat Bhatkar, Manoj Kumar Goyal, Manish Modi, Sahil Mehta, Vivek Lal, Sameer Vyas
Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
|Date of Web Publication||20-Nov-2015|
Dr. Manoj Kumar Goyal
Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhatkar S, Goyal MK, Modi M, Mehta S, Lal V, Vyas S. The owl and the monkey - The varied faces of pons in central pontine myelinolysis. Neurol India 2015;63:996
Central pontine myelinolysis is a non-inflammatory demyelinating disease of the white matter tracts traversing the pons. Here we review a case with classical MRI findings.
A 60-year-old diabetic and hypertensive man presented with a history of altered sensorium following rapid correction of hyponatremia elsewhere. The hyponatemia most likely occured secondary to diuretic use. Over the next few days, his sensorium gradually improved, but he had severe rigidity, bradykinesia, spasticity in all the limbs, brisk deep tendon reflexes, and extensor plantar responses. Brain MRI showed T2- and FLAIR-hyperintense and corresponding T1-hypointense signal changes occuring in the central transverse corticopontine fibers, with relative sparing of the peripheral pontine fibers and the descending corticospinal tracts. A diagnosis of central pontine myelinolysis (CPM) was made, and the patient was treated symptomatically with drugs and rehabilitation measures. He recovered well and is independent in all his activities of daily living at a 3-month follow-up.
Central pontine myelinolysis is a noninflammatory demyelinating disease of the white matter tracts traversing the pons. There is typical sparing of the peripheral pontine fibres and the descending corticospinal tracts. This results in a typical "owl's eye appearance" on axial T2-weighted MRI [Figure 1]a. The corresponding T1-weighted images may show a characteristic pattern of signal alteration in the basal pons that resembles the face of a monkey, hence giving rise to the "monkey sign" [Figure 1]b.
|Figure 1: (a) T2-axial-weighted MR images showing the hyperintense signal changes involving the transverse pontine fibers, with sparing of the tracts (blue arrow), giving the appearance of owl's eyes; (b) T1-axial-weighted MR image showing the hypointense signal changes involving the transverse pontine fibers (yellow arrow), with sparing of the corticospinal tracts (blue arrow), giving the appearance of face of a monkey|
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Soto-Cabrera E, Gonzalez A, Carrillo R, Santos-Zambrano J. Monkey sign in central pontine myelinolysis—a new proposed imaging sign. Neuroimaging 2008 [18th
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