Osmotic demyelination syndrome

Case contributed by Dr Lemuel Marquez Narcise

Presentation

Seizures.

Patient Data

Age: 25 years
Gender: Male

MRI selected images centered on the pons

MRI

Selected MRI images shows a trident-shaped pontine lesion, hypointense on T1WI and hyperintense on T2WI/FLAIR. DWI sequence shows peripheral restricted diffusion outlining the lesion.

  • Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

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 in 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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