Central pontine myelinolysis and chronic acquired hepatocerebral degeneration: A case report

A 36-year-old male was a victim of alcoholic liver cirrhosis. He was admitted for esophageal varices (EV) bleeding. During hospitalization, conscious disturbance with quadriplegia developed after hyponatremia had been rapidly corrected. Under a tentative diagnosis of central pontine myelinolysis (CPM), MR images was done and hyperintense lesions in T2WI in the pontine bases were found mainly located in midline, which were consistent with central pontine myelinolysis. Besides, symmetrical hyperintense lesions were also found in the bilateral basal ganglia, head of caudate nucleus, subthalamic nuclei and mesencephalon in both T1WI and T2WI, typical findings of chronic acquired hepatocerebral degeneration (CAHD). The concurrence of these two disorders had been reported by Shiraki (1968) clinically and pathologically, but MR images with concomitant CAHD and CPM have never been reported. We present this rare case and we postulate that MR image might be an important tool in the diagnosis of CAHD and CPM. The possible pathogenesis of these two disorders are also briefly reviewed.