PMC8462895_01
(a) MRI on 21 August 2020, with stable bilateral frontal, parietal and right occipital encephalomalacia. Mild atrophy and chronic small vessel ischemic disease. (b) MRI on 16 September 2020 with trident-,shaped T2 hyperintense signal within the central pons consistent with osmotic demyelination. T2 hyperintense signal is seen within the splenium of the corpus callosum, bilateral corpus striatum and within bilateral insular cortices which are most likely secondary to hyperammonemia but can also be seen in extrapontine myelinolysis
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The patient received both a head CT and MRI, which demonstrated stable multifocal cortical encephalomalacia as well as mild atrophic, chronic small vessel ischemic disease (Figure 1(a)). The head MRI was repeated and was remarkable for osmotic demyelination involving the central pons, splenium of the corpus callosum, bilateral corpus striatum and within bilateral insular cortices (Figure 1(b)).