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Axial T2.

Cor T2.

Axial T1 post contrast.

Acute demyelination affecting brainstem

Incompletely understood

Related to rapid correction of electrolyte abnormalities

Symptoms include confusion, dysarthria, dysphagia, weakness

Symptoms usually develop 2-3 days after electrolyte correction

Characteristic MR findings develop after 3-6 days after onset of symptoms.

Imaging:

Expansion of pons

Hyperintense T2/Hypointense T1

Symmetic involvement with relative sparing of peripheral tissue

Round, triangular, butterfly-shaped central hyperintensity.

Extrapontine myelinolysis

Basal ganglia

Cerebral hemispheres

Can occur with/without central pontine myelinolysis.