Osmotic demyelination syndrome

Case contributed by Saad Ahmed Saad Hassan


Unsteady balance, tremors and limb ataxia.

Patient Data

Age: 45 years
Gender: Male

A trident-shaped area of an abnormal signal is seen involving the center of the pons with sparing of its periphery and the cortico-spinal tracts. This area elicits restricted diffusion on DWI, as well as mild high signal intensity on both T2WI and FLAIR.

Case Discussion

MRI findings are consistent with osmotic demyelination syndrome. This patient presented with alcohol withdrawal syndrome and refeeding syndrome.

Pontine strokes would be expected to not cross the midline.

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