Osmotic demyelination syndrome

Case contributed by Dr Lemuel Marquez Narcise


Patient presented with seizures.

Patient Data

Age: 25 years
Gender: Male

MRI selected images centered in the pons

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.

Case Discussion

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.

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Case information

rID: 44204
Published: 11th Apr 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Excluded from licensing

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