Osmotic demyelination syndrome
Patient presented with seizures.
MRI selected images centered in the pons
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Selected MRI images shows a pontine lesion which is hypointense on T1 and hyperintense on T2/FLAIR. DWI sequence shows peripheral restricted diffusion outlining the lesion. The axial images show the "trident"-shaped lesion.
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This patient had had hyponatremia and dehydration corrected recently.
Osmotic demyelination syndrome was formerly known as central pontine myelinolysis. It classically occurs when there is an increase in the serum sodium levels caused by rapid correction of hyponatremia as presented by this case.
The typical image characteristic of this lesion on MRI can be round, triangular, "bat wing"-shaped, or "trident"-shaped which is hyperintense on T2WI/FLAIR and hypointense on T1WI, and demonstrates restricted diffusion.