Neuroimaging: pontine myelinolysis: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Neuroimaging: pontine myelinolysis

Sample item

A patient develops quadriparesis and pseudobulbar signs days after rapid correction of severe hyponatraemia. Which MRI finding is expected?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Symmetrical T2 hyperintensity in the central pons

Osmotic demyelination causes symmetrical non-enhancing lesions of the central pons (trident or bat wing shape), sometimes with extrapontine involvement. It follows rapid sodium correction (above 8 to 10 mEq/L in 24 hours), especially in alcoholics. Imaging changes can lag clinical signs by 1 to 2 weeks.

Option by option

  • A. Mammillary body hyperintensity

    Mammillary body changes are seen in Wernicke encephalopathy.

  • B. Symmetrical T2 hyperintensity in the central pons (correct)

    Correct. Central pontine hyperintensity matches osmotic demyelination.

  • C. Cerebellar vermis mass

    A vermian mass suggests a posterior fossa tumour.

  • D. Bilateral temporal lobe oedema

    Temporal lobe oedema suggests herpes encephalitis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is B, Symmetrical T2 hyperintensity in the central pons. Osmotic demyelination causes symmetrical non-enhancing lesions of the central pons (trident or bat wing shape), sometimes with extrapontine involvement.

Why is "Mammillary body hyperintensity" not the answer?

Mammillary body changes are seen in Wernicke encephalopathy.

Why is "Cerebellar vermis mass" not the answer?

A vermian mass suggests a posterior fossa tumour.

Why is "Bilateral temporal lobe oedema" not the answer?

Temporal lobe oedema suggests herpes encephalitis.

What concept does this question test?

It tests Neuroimaging: pontine myelinolysis in Radiology. It follows rapid sodium correction (above 8 to 10 mEq/L in 24 hours), especially in alcoholics. Imaging changes can lag clinical signs by 1 to 2 weeks.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuroimaging: pontine myelinolysis?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.