Magnetic Resonance Imaging in Osmotic Demyelination Syndrome

increase in serum sodium, his Glasgow Coma Scale decreased indicating low conscious level, thus necessitating intubation.Serum sodium levels stabilised thereafter, but there were no improvement in conscious level.The patient appeared to be in a 'locked-in' state.Magnetic Resonance Imaging (MRI) (shown below) revealed central pontine and extrapontine myelinolysis with T2 hyperintensity at the pons (Trident sign) (A) as well as the putamen and caudate nucleus (B) and restricted diffusion on Diffusion Weighted Imaging (DWI) mapping (C) and Apparent Diffusion Coefficient (ADC) mapping (D).][3] Plasma exchange was done, but he showed no significant neurological recovery (Figure 1 & 2).