Cirrhosis of liver without mention of alcohol [571.5], Reason for Study: ^Reason: eval for source of encephalopathy History: sp liver txp Abnormal high signal intensity lesions involving pons and bilateral thalami are again demonstrated. Those lesions are now showing low signal intensity on T1 and high signal intensity on T2, thus indicating focal tissue losses.On Gad enhancement, there is no evidence of contrast enhancement.On ADC maps, restricted diffusion areas of pons and bilateral thalami are now normalized which showed diffusion restrictions. The constellation of above findings and sequential changes of MR characteristics are highly suggestive for central pontine myelinolysis with extrapontine involvement. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
Constellation of current MR findings and sequential changes of MR characteristics of pontine and bilateral thalamic lesions highly suggestive of central pontine myelinolysis with extrapontine involvement.