An MR study performed on a patient who presented a tetraplegia after l
iver transplantation, revealed bilateral hypersignal of internal globu
s pallidus on T2 weighted images. Diagnosis of extrapontine myelinolys
is was proposed based on clinical presentation and lesions topography,
although absence of natremic disorders. Confirmation of diagnosis was
obtained on an MR study performed a month later, which demonstrated a
pontine extension. Extrapontine myelinolysis can precede pontine invo
lvement. Diagnosis of myelinolysis should be evoked although MR normal
appearence of the pons.