This patient has osmotic demyelination syndrome (ODS), also known as central pontine myelinolysis. The MRI demonstrates the characteristic “trident sign” or “omega sign” seen in ODS. The trident sign is typically seen in T2/FLAIR sequences and is due to demyelination of the transverse pontine fibers while sparing the descending corticospinal tracts. This finding can usually be seen within 24 hours of the onset of symptoms.