Osmotic demyelination syndrome: reversible MRI findings in bilateral cortical lesions.

A 70-year-old man who suffered from osmotic demyelination syndrome (ODS) is presented. Dyspnea, pseudobulbar palsy and motor weakness were seen. MRI in the acute stage revealed focal abnormal high-signal lesions in the pons, thalamus and bilateral cortical areas on T1-weighted and FLAIR images. With corticosteroid therapy he recovered from his dyspnea and severe pseudobulbar palsy, and the spastic quadriplegia gradually improved. One year later the brain lesions had disappeared on T1-, T2-weighted and FLAIR images. To detect the cortical or subcortical lesions in ODS, FLAIR imaging should be performed routinely.