The Trident in the Brain- A Case of Osmotic Demyelination Syndrome Secondary to Alcohol Withdrawal

Abstract

Osmotic Demyelination Syndrome (ODS) is characterised by demyelination of pons and is also called as central pontine myelinolysis. It has been observed in patients with alcohol dependence, although hyponatraemia remains the most common cause. It should be suspected in chronic alcoholics and especially in those with protracted delirium tremens. Magnetic Resonance Imaging (MRI) is the modality of choice to diagnose this condition with a trident or pig snout appearance of pons being the characteristic finding. This publication discusses the case of a 27-year-old male who reported to the casualty ward in a delirious state following an episode of tonic clonic seizures and was diagnosed with alcohol withdrawal with pontine myelinolysis.

Keywords

• hyponatraemia
• pig’s snout appearance
• pons
• tonic clonic seizures