Osmotic myelinolysis is a distinctive clinical syndrome with a characteristic "bat wing" MRI lesion in the central pons, which is also called central pontine myelinolysis (CPM). However, demyelinating lesions are not only limited to the central pons, but also may be involved in the extrapontine regions including the basal ganglia, thalamus, and cerebellum (extrapontine myelinolysis; EPM). We report an atypical case of osmotic myelinolysis confined to the pyramidal tract from the precentral gyrus to the central pons via the corona radiata and internal capsule in a MR image.
Basal Ganglia ; Cerebellum ; Internal Capsule ; Magnetic Resonance Imaging ; Myelinolysis, Central Pontine ; Pons* ; Pyramidal Tracts* ; Thalamus

PURPOSE: Multiple rib fracture (MRF) and a hemopneumothorax accompany with most blunt chest traumas. We aimed to analyze the factors increasing the probability of a hemopneumothorax. In addition, other injuries accompanying MRF were analyzed. METHODS: We retrospectively reviewed the medical records of 154 mutiple rib fracture patients who visited our hospital between January 2005 and December 2007. The medical records were reviewed for sex, age, mechanism of injury, location, number of fractures, distance of dislocated rib fragments, and presence of complications. We measured the distance of bony dislocations by using the PACS (Picture Archiving and Communication System). RESULTS: The average number of rib fractures was 3.7+/-2.1, and the number of rib fractures significantly influenced the incidence of a hemothorax (p<0.001). The risk of a phemothorax was increased in a bilateral MRF compared to a unilateral MRF (p=0.027). The distance of dislocated rib fragments influenced the probability of a hemothorax significantly (p=0.018), and subcutaneous emphysema and lung contusion were significantly associated with a pneumothorax (p=0.021, p=0.036). CONCLUSION: The number of MRFs did not influence the risk for a pneumothorax, but did influence the risk for a hemothorax. The laterality, distance of dislocation, also had an influence on the risk for a hemothorax. Also, subcutaneous emphysema and lung contusion were increased in cases with a pneumothorax. We must consider the possibility of a hemothorax even when the initial chest X-ray shows no evidence of a hemothorax. If a lung contusion is present, then an occult pneumothorax must be considered.
Contusions ; Dislocations ; Hemopneumothorax ; Hemothorax ; Humans ; Incidence ; Lung ; Medical Records ; Pneumothorax ; Retrospective Studies ; Rib Fractures ; Ribs ; Subcutaneous Emphysema ; Thorax