Trident sign - osmotic demyelination

Case contributed by Brendon Friesen
Diagnosis almost certain

Presentation

Seizures, ethanol dependence, and mild hyponatremia.

Patient Data

Age: 60-year-old
Gender: Female

MRI Brain

mri
This study is a stack
Axial
T2
This study is a stack
Axial
FLAIR
This study is a stack
Axial
DWI
This study is a stack
Axial
ADC
This study is a stack
Axial
SWI
This study is a stack
Axial
T1
Download
Info

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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