Reversible Clinical and Magnetic Resonance Imaging of Central Pontine Myelinolysis Following Surgery for Craniopharyngioma : Serial Magnetic Resonance Imaging Studies

An 18-year-old girl presented with central pontine myelinolysis (CPM) following surgery for craniopharyngioma. Postoperatively, the patient developed diabetes insipidus with remarkable fluctuation of serum sodium level, suffered a seizure, and developed mental state changes and quadriparesis. Magnetic resonance (MR) imaging obtained soon after the development of the symptoms showed no significant abnormalities. MR imaging obtained 2 months later demonstrated typical trident or bat-like signal abnormalities in the center of the pons, compatible with CPM. Serial MR imaging obtained at 7 and 10 months showed the lesion had decreased in size or almost completely resolved and the patient almost completely recovered. CPM is well known, but neurosurgeons should consider the possibility following surgery for craniopharyngioma.