REVERSIBLE WHITE-MATTER LESIONS IN A PATIENT WITH FULMINANT-HEPATITISAND ACUTE-RENAL-FAILURE

A 36-year-old man developed fulminant hepatitis and acute renal failur e with profound hyponatremia (116 mEq/L). Emergent hemodialysis correc ted the serum sodium to 136 mEq/L within 24 hours. He developed genera lized convulsions 11 days later. Magnetic resonance imaging (MRI) reve aled a single large symmetrical lesion in the pons and extensive white matter lesions in the bilateral occipital, temporal, parietal and rig ht frontal regions. These lesions showed marked resolution as the pati ent recovered. Fulminant hepatitis and acute renal failure could induc e extensive edema in the cerebral white matter. Therefore, not all MRI abnormalities in the white matter after correction of hyponatremia ne cessarily reflect myelinolysis.