Morel's laminar necrosis like findings on MRI in a case of extra-pontine myelinolysis

A 39-year-old man developed disturbance of consciousness with hyponatremia during the treatment of schizophrenia in another hospital. He became alert after the correction of hyponatremia. But his consciousness deteriorated one day later in spite of normal serum sodium level, then he was referred to our hospital. The disturbance of consciousness, quadriparesis and rigidity were persisted even 4 months later. MRI (T2WI) showed well defined high intensity areas along the deep layer of the cerebral cortex and in the bilateral basal ganglia. But there were no lesions in the pons on MRI. Therefore, the diagnosis was made as extra-pontine myelinolysis (EPM) without apparent central pontine myelinolysis (CPM) according to the MRI findings. Recently, the EPM without CPM has been reported in 3 patients. Two cases were examined pathologically, findings of which were characterized by Morel's laminar necrosis at the deep layer of the cerebral cortex. But there is no report in the literature describing the detection of Morel's laminar necrosis on antemortem MRI. It seemed that the MRI findings of our case indicated Morel's laminar necrosis. Our case is suggestive in relation to the pathogenesis of EPM and CPM.