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|Year : 2021 | Volume
| Issue : 3 | Page : 777-778
“Mercedes Benz Sign: Osmotic Demyelination Syndrome”
Amith S Kumar, Darakshan Naheed, Neeraj Balaini, Sahil Mehta, Vivek Lal
Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
|Date of Submission||25-Jun-2017|
|Date of Decision||25-Jul-2017|
|Date of Acceptance||08-Aug-2019|
|Date of Web Publication||24-Jun-2021|
Dr. Sahil Mehta
Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar AS, Naheed D, Balaini N, Mehta S, Lal V. “Mercedes Benz Sign: Osmotic Demyelination Syndrome”. Neurol India 2021;69:777-8
A 34-year-old man with a history of alcohol abuse was transferred from local hospital with a history of vertigo, unsteadiness, nausea, vomiting, and fatigue followed by subacute onset quadriparesis. He reported to have had 10–20 episodes of large volume watery stools five days prior to the onset of neurological deficits. Neurological examination revealed bilateral coarse gaze evoked nystagmus, bilateral facial hypoesthesia, bilateral peripheral facial paralysis, quadriparesis with extensor plantar reflex on the left side. The deep tendon reflexes were brisk with gait ataxia. His routine investigations including renal function tests and electrolytes were normal with no history of rapid correction of hyponatremia. Cerebrospinal fluid analysis was within normal limits. Cranial MRI performed on day two of hospitalization showed T1 hypointense and T2 hyper intense triangular lesion in the central pons with minimal diffusion restriction and no contrast enhancement simulating “Mercedes Benz Sign” [Figure 1]. He was managed conservatively and showed significant improvement at three months follow up.
|Figure 1: Demonstrates (a) T1 hypointense, (b and c) T2 and FLAIR hyperintense triangular lesion in the center of pons with mild diffusion restriction (d and e) simulating “Mercedes Benz Sign” (f) T1W Sagittal section of brain|
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Osmotic Demyelination Syndrome (ODS) was first defined and described by Adams and colleagues in 1959. One of the most important risk factors for development of ODS is rapid correction of hyponatremia. But, ODS has been reported in normonatremic and hypernatremic patients also, especially when associated with chronic alcoholism, diabetes mellitus, hypokalemia, liver transplantation, pituitary surgery, hepatocellular dysfunction, hypophosphatemia, lithium toxicity, and chronic kidney disease., Classical radiological picture of central pontine myelinolysis involves central pons with sparing of pontine tegmentum and ventrolateral pons giving the appearance of various signs namely trident sign, piglet sign, and butterfly sign.,
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| » References|| |
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