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Trident-shaped appearance of central pons in osmotic demyelination syndrome (axial T2 MRI)

Trident-shaped appearance (trident sign or omega sign) of central pons in an axial T2-weighted image (blue arrow) in osmotic demyelination syndrome. The characteristic “trident”-shaped appearance is attributed to the involvement of the transverse pontine fibers and relative sparing of the descending corticospinal tracts. (Source: Koul P, Harjpal P, Raghumahanti R. Osmotic demyelination syndrome: a rare clinical image. Diagnostics [Basel] 2023;13[21]:3393. Creative Commons Attribution 4.0 International [CC BY 4.0] license, creativecommons.org/licenses/by/4.0.)

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  • Alcoholism
  • Extrapontine myelinolysis
  • Hyperosmolar hyperglycemic state
  • Hypokalemia
  • Malnutrition
  • Osmotic myelinolysis