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Increased signal intensity in the lentiform and caudate nuclei in osmotic demyelination syndrome (axial FLAIR)

Axial FLAIR sequence at onset of symptoms in osmotic demyelination syndrome showing symmetrical increased signal intensity in the lentiform and caudate nuclei bilaterally. (Source: Siranart N, Nakaphan P, Viarasilpa V, Anukoolwittaya P, Hemachudha P. Hand knob sign in osmotic demyelinating syndrome. BMC Neurol 2024;24[1]:83. Creative Commons Attribution 4.0 International [CC BY 4.0] license, creativecommons.org/licenses/by/4.0.)

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Associated Disorders

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