The authors describe two patients with clinical manifestations of the osmotic demyelination syndrome (ODS) and unusual MRI findings of gadolinium-enhancing peripheral cortical abnormalities. They propose that these represent extrapontine manifestations of ODS because neither patient had a notable hypoxic-ischemic insult. Recognizing this imaging appearance is important because prognosis in ODS may be less uniformly grim than for hypoxia-ischemia.