History of osmotic demyelination. There is interval decreased prominence of the T2 hyperintense lesions in the bilateral basal ganglia, thalami, and pons, as well as resolution of the associated restricted diffusion related to the prior osmotic demyelination event. There is unchanged mild, diffuse, nonspecific, bilateral periventricular white matter T2 hyperintensity. There has also been mild interval increased prominence of the ventricular system and sulci due to cerebral volume loss. There is faint patchy T1 hyperintensity in the bilateral basal ganglia and cerebral peduncles. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Interval evolution of the pontine and extrapontine myelinolysis with resolution of the associated edema and resultant diffuse cerebral volume loss.2. Faint patchy T1 hyperintensity in the bilateral basal ganglia and cerebral peduncles may be secondary to chronic hepatic encephalopathy. 