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NEUROIMAGE
Year : 2015  |  Volume : 63  |  Issue : 6  |  Page : 996

The owl and the monkey - The varied faces of pons in central pontine myelinolysis


Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India

Date of Web Publication20-Nov-2015

Correspondence Address:
Dr. Manoj Kumar Goyal
Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.170084

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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

How to cite this URL:
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 [serial online] 2015 [cited 2022 Aug 16];63:996. Available from: https://www.neurologyindia.com/text.asp?2015/63/6/996/170084


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"[1] 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.[2]
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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 » References Top

1.
Arora A, Kapoor A, Upreti L, Puri SK. Animals in the Brain. European Society of Radiology (ECR) 2011. p. 1-29. http://dx.doi.org/10.1594/ecr2011/C-0401 (abstract).  Back to cited text no. 1
    
2.
Soto-Cabrera E, Gonzalez A, Carrillo R, Santos-Zambrano J. Monkey sign in central pontine myelinolysis—a new proposed imaging sign. Neuroimaging 2008 [18th Meeting of the European Neurological Society 07.06.2008-11.06.2008] (abstract).  Back to cited text no. 2
    


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