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T2 Hyperintense Pontine Abnormalities
A 42-year-old woman presenting with orthostasis and hyponatremia. Ax, axial; DWI, diffusion-weighted imaging; FLAIR, fluid attenuated inversion recovery.
A 71-year-old man presenting with slurred speech and difficulty with hand-mouth coordination. Ax, axial; DWI, diffusion-weighted imaging; FLAIR, fluid attenuated inversion recovery.
A 34-year-old man presenting with choking episodes, right-sided weakness, and urinary incontinence. Ax, axial; DWI, diffusion-weighted imaging; FLAIR, fluid attenuated inversion recovery.
DESCRIPTION OF FINDINGS
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Case A: An axial FLAIR image demonstrates central hyperintensity of the pons with sparing of the peripheral fibers. Diffusion-weighted MRI shows corresponding restricted diffusion (confirmed by ADC, not shown). T1-weighted precontrast and postcontrast MRI discloses no corresponding enhancement.
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Case B: An axial FLAIR image illustrates a left-sided paramedian focus of signal hyperintensity. DWI demonstrates a corresponding wedge-shaped area of restricted diffusion that does not traverse the midline (confirmed by ADC; not shown). T1-weighted precontrast and postcontrast MR images show no enhancement.
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Case C: An axial FLAIR image reveals an expansile region of ventral signal hyperintensity traversing the midline. Diffusion-weighted MRI shows a matching area of restricted diffusion (confirmed by ADC; not shown). T1-weighted precontrast and postcontrast MRI discloses heterogeneous enhancement of the T2-hyperintense lesion.
Diagnosis
Case A
Osmotic demyelination
Case B
Basilar perforating artery infarction
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