Central pontine myelinolysis in diffuse large B-cell lymphoma, a case series and literature review

Figures

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  Fig. 1. Case 1. Axial and coronal T1 post contrast images showing diffuse supratentorial pachymeningeal enhancement, with prominent thickening along the dura in the medial temporal regions (A, B). Axial T2 MRI of the brain showing central pontine high signal intensity sparing the periphery, with no enhancement (C, D). Follow-up MRI 9 months after chemotherapy showing resolution of the previously noted central pontine high T2 signal intensity (E) and regression of the previously observed central skull base and pachymeningeal enhancement (F)

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  Fig. 2. Case 2: T2 WI axial brain showing incidental central pontine lesion (A) that had restriction on DWI (B) and not enhancing (C). Axial FLAIR MRI reveals intra-axial lesion centered in the genu of the left internal capsule with significant surrounding vasogenic edema, mass effect (D) and heterogeneous enhancement on T1WI (E). Follow up MRI shows resolution of the pontine lesion on FLAIR axial images (F) and DWI (G) as well as the internal capsule lesion (H)

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  Fig. 3. Case 3 Central pons hyperintensity on axial T2-weighted images, showing the “trident-shaped” sign (A). Coronal T2WI showing the “bat-winged” sign with high signal intensity (B). The lesion demonstrates restriction on DWI and appears hypointense on the ADC map (D, E). Axial post-contrast T1-weighted images showing the lesion as hypointense with no enhancement (C). Positron Emission Tomography scan of the brain performed at the time of MRI showing no abnormal FDG uptake (F). Resolution of the lesion following chemotherapy (G)