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Osmotic Demyelination Syndrome: Trident Sign.

Abdeali Ginwala¹, Vinay Thorat², Sunil Jawale³

¹Resident, Department of Internal Medicine, Poona Hospital and Research Centre, Pune, Maharashtra, India, Corresponding Author.

The Journal of the Association of Physicians of India

|October 11, 2024

Summary

Severe hyponatremia correction led to osmotic demyelination syndrome (ODS) in a patient. Magnetic resonance imaging revealed characteristic ODS findings, necessitating supportive care and sodium level management.

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Area of Science:

Neurology
Internal Medicine
Radiology

Background:

Severe hyponatremia, defined by serum sodium levels below 135 mEq/L, presents significant clinical challenges.
Rapid correction of hyponatremia is a known risk factor for neurological complications.
Osmotic demyelination syndrome (ODS) is a serious consequence of overly rapid sodium level increases.

Observation:

A 72-year-old female presented with severe hyponatremia (serum sodium 102.5 mEq/L).
The patient's sodium levels were rapidly increased following initial management.
This rapid correction precipitated the development of osmotic demyelination syndrome.

Findings:

Magnetic resonance imaging (MRI) is the gold standard for diagnosing ODS.
MRI demonstrated the classic trident-shaped hyperintensity in the central pons, indicative of ODS.
The findings confirmed the diagnosis of osmotic demyelination syndrome.

Implications:

Early recognition and diagnosis of ODS via MRI are crucial.
Management strategies for ODS include intensive supportive care.
Readjustment of serum sodium levels, potentially involving relowering, may be required in ODS patients.
This case underscores the importance of cautious sodium correction protocols in managing hyponatremia.