Trident sign - osmotic demyelination

Case contributed by Brendon Friesen


Seizures, ethanol dependence, and mild hyponatremia.

Patient Data

Age: 60-year-old
Gender: Female

MRI Brain


Central pontine T2 hyperintensity and diffusion restriction with "trident" configuration, with peripheral sparing, consistent with osmotic demyelination.

Severe supratentorial chronic ischemic change.

Case Discussion

Central pontine osmotic demyelination with the "trident sign".

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