Clinical resolution of osmotic demyelination syndrome following. Sep 02, 2019 osmotic demyelination syndrome ods, which embraces central pontine myelinolysis cpm and extrapontine myelinosis epm, is often underdiagnosed in clinical practice, but can be fatal. Among all 106 cases, 49 presented with isolated central. Osmotic demyelination syndrome was suggested by sternsetal1inpatientswhohadbothcentral pontine and extrapontine foci of myelinolysis. Osmotic demyelination syndrome, demonstrating as cpm, is a devastating neurologic disorder that often develops after rapid correction of chronic hyponatremia. However, in recent years, a variety of other medical conditions have been associated with the development of ods, independent of changes in serum sodium.
The osmotic demyelination syndrome is a complication of treatment of patients with profound, life threatening hyponatraemia. Pdf osmotic demyelination syndrome ods and overly rapid. The patients motor function deteriorated to a nearly locked in syndrome. Osmotic demyelination syndrome ods occurs after rapid overcorrection of severe chronic hyponatremia usually in those with a predisposition such as chronic alcoholism, malnutrition, or liver disease. In this state, brain cells are highly sensitive to rapid changes in concentrations of effective osmoles. Osmotic demyelination syndrome ods is a general term that has become commonplace in the practice of medicine, encompassing both central pontine myelinolysis and extrapontine myelinolysis. A sh r afn,l ockl eyr ii t z d nu p tm with death or neurologic damage in outpatients. The osmotic demyelination syndrome ods is a central nervous system disorder that results from neuronal damage related to abrupt. Osmotic demyelination syndrome in children sciencedirect. It is important to identify patients at risk from osmotic demyelination syndrome and to correct their hyponatraemia appropriately. Complete recovery of chronic osmotic demyelination. This article requires you to have a account to view the full text.
A case of osmotic demyelination syndrome occurred after. Central pontine myelinosis and osmotic demyelination syndrome. Osmotic demyelination syndrome results from overly rapid serum sodium correction and is often iatrogenic. Prevention and treatment of the osmotic demyelination syndrome. Osmotic demyelination syndrome refers to acute demyelination seen in the setting of osmotic changes, typically with the rapid correction of hyponatremia. Treatment response in osmotic demyelination syndrome. This case report demonstrates that if serum sodium is re lowered early in the course of osmotic demyelination syndrome ods, many of its devastating consequences may be avoided. It occurs as a consequence of a rapid rise in serum tonicity in individuals with chronic severe hyponatraemia who have made intracellular adaptations to the prevailing hypotonicity. Manifestations of osmotic demyelination syndrome can.
Pdf osmotic demyelination syndrome ods is an acute demyelination process that usually occurs several days following an osmotic stress. Introduction pontine myelinolysis pm was first described in 1959 by adams et al. Osmotic demyelination syndrome due to hyperosmolar hyperglycemia. When the myelin sheath that covers nerve cells is destroyed, signals from one nerve to another arent properly transmitted. Risk factors and outcomes of rapid correction of severe. Osmotic demyelination syndrome is a devastating condition which is largely preventable. Severe hyponatraemia carries a risk of cerebral oedema with a significant mortality, yet correcting it too rapidly can result in osmotic demyelination syndrome, again with potentially disastrous consequences. Therapeutic relowering of plasma sodium after overly rapid.
Pdf on jul 8, 2014, christian bornke and others published osmotic demyelination syndrome find, read and cite all the research you need. Osmotic demyelination syndrome radiology reference article. Bartley2 1 registrar in anaesthetics, university hospital of north tees, hardwick road, stockton, uk. However, in recent years, a variety of other medical conditions have been associated with the development of ods, independent of. Methods twenty five consecutive patients with ods formed the study cohort. However, it may occur even after slow correction of hyponatremia. Osmotic demyelination syndrome in children pediatric. Osmotic demyelination syndrome ods and overly rapid correction. Gocht and colmant 2 reported extrapontine myelinolysisin53%of58autopsiesofpatients with syndrome and identified the areas most frequently involved as the cerebellum, lateral. The exact mechanism of demyelination is poorly understood but it has been.
It is caused by the destruction of the layer myelin sheath covering nerve cells in the middle of the brainstem pons. It is the more recent term replacing central pontine myelinolysis, recognizing that extrapontine structures can also be affected, previously known as extrapontine myelinolysis. The pathogenesis of osmotic demyelination syndrome remains unclear, but many underlying diseases are known to. Bodensteiner, md 10 days later, she began to have an unsteady gait, uncoordinated arm movements, and dysarthia treated with sodium benzoate and sodium. We report a case of ods secondary to overcorrection of severe hyponatremia with pathognomonic clinical and radiologic signs making a complete. In a recent study of 34 patients with osmotic demyelination syndrome two died, and, of the remaining 32, a third recovered, a third were debilitated but independent, and a third were dependent. Aims to assess the functional and clinical outcome in a sizeable cohort of patients with osmotic demyelination syndrome ods and to characterise the factors which could predict the final outcome. Slow correction of serum na less than 12 mmollday is recommended to prevent the emergence of this syndrome. Osmotic demyelination syndrome ods is an uncommon disorder, characterized by noninflammatory demyelination involving the pons and other areas of the central nervous system, which may occur for instance as a consequence of an overly rapid correction of hyponatraemia. Clinical and functional outcome and factors predicting. Following supportive treatment he made a full recovery. Relowering of serum na for osmotic demyelinating syndrome. Pdf osmotic demyelination syndrome in children researchgate.
Complete recovery of chronic osmotic demyelination syndrome. Chest postgraduate education corner emcrit project. Recommendations for treatment of symptomatic hyponatremia. The diagnosis of ods was based on clinical features with corroborating imaging. Axial fatsaturated t2weighted image showing hyperintensity in the pons with sparing of the peripheral fibers, the patient was an alcoholic admitted with a serum na of 101 treated with hypertonic saline, he was left with quadreparesis, dysarthria, and altered mental status. Relowering of the patients serum sodium with dextrose 5% and desmopressin. Case report osmotic demyelination syndrome following rapid correction of hyponatraemia d. Trident sign in osmotic demyelination syndrome qjm. However, brain adaptations that reduce the risk of cerebral edema make the brain vulnerable to injury if chronic hyponatremia is too rapidly corrected. Although it is recognised that osmotic demyelination syndrome is a rare disease, its dramatic clinical course points out the importance in different disciplines. We suggest that the osmotic demyelination syndrome is a preventable complication of overly rapid correction of chronic hyponatremia. Damned if we do, damned if we dont oh ms, kim hi, carrol hj. Complete recovery of chronic osmotic demyelination syndrome with plasma exchange published. Osmotic demyelination syndrome ubaidur rahaman senior resident, critical care medicine sanjay gandhi post graduate institute of medical sciences, lucknow, india 2.
Case report osmotic demyelination syndrome following. Among all 106 cases, 49 presented with isolated central pontine myelinolysis. The osmotic demyelination syndrome ods has been a recognized complication of the rapid correction of hyponatremia for decades. Osmotic demyelination syndrome due to hyperosmolar. We report a case of ods secondary to overcorrection of severe hyponatremia with pathognomonic clinical and radiologic signs. Osmotic demyelination syndrome encompasses central pontine demyelination as well extrapontine demyelination and is seen in alcoholics and malnourished individuals associated with rapid correction of hyponatremia 1,2. Case report osmotic demyelination syndrome following rapid. May 01, 2009 unenhanced ct performed shortly after the patient was transferred to the tertiary care center revealed a large wellcircumscribed area of hypoattenuation within the pons, fig 1a, with bilateral symmetric foci of hypoattenuation in the thalami, fig 1b, findings suggestive of osmotic demyelination syndrome. Osmotic demyelination syndrome ods is brain cell dysfunction. The serum sodium concentration is the primary determinant of serum tonicity also known as effective serum osmolality see. Of the numerous organic causes for seizures, pontine myelinolysis is one of the rarest.
Osmotic demyelination syndrome after correction of. Osmotic demyelination syndrome is a wellknown clinicopathologic entity characterized by edema and demyelination in the pons and extrapontine areas 15. Osmotic demyelination syndrome ods was first reported in 1959 by adams and victor among malnourished patient and patient with chronic alcoholism. Osmotic demyelination syndrome commonly affects the pons and infrequently involves the extrapontine region. Osmotic demyelination syndrome ods is a general term that has become commonplace in the practice of medicine, encompassing both central pontine. Osmotic demyelination syndrome following correction of. Osmotic demyelination syndrome, central pontine demyelination. During chronic hyponatremia, brain cells gradually attain a new osmotic balance with the interstitial space and thereby limit cerebral edema. Osmotic demyelination syndrome is extremely rare in patients with plasma sodium 120 meql incidence as low as 0. Also known as osmotic demyelination syndrome ods, pm is subdivided into central pontine myelinolysis cpm and extrapontine myelinolysis epm 2. You do not have access to the full text of this article, the first page of the pdf of this article appears above. In the event that it occurs, plasmapheresis is promising in aiding neurological recovery. Magnetic resonance imaging of the brain revealed findings consistent with osmotic demyelination syndrome ods 5.
However, in recent years, a variety of other medical conditions have been associated with the development of ods, independent. Hameed raina 1, irfan yusuf wani 2 abstractpurpose. Osmotic demyelination syndrome definition of osmotic. Osmotic demyelination syndrome ods occurs after rapid overcorrection of severe chronic hyponatremia usually in those with a. A case of osmotic demyelination syndrome occurred after the. Previous studies have noted the mri findings of osmotic demyelination syndrome in various patient groups 3, 4. Although it is recognised that osmotic demyelination syndrome is a rare disease, its dramatic clinical course points. The diagnosis of ods was based on clinical features with corroborating imaging findings. Osmotic demyelination syndrome following slow correction of hyponatremia. Rapid sodium correction in this state results in shrinkage of brain cells. The neurologic manifestations associated with overly rapid correction have been called the osmotic demyelination syndrome ods. Subcortical white matter lesions in osmotic demyelination. Osmotic demyelination syndrome presenting with chorea t ravindran1, paneerselvam2, radha2, t allwyn yabesh 3 abstract osmotic demyelination syndrome is an acute shift in serum osmolality causing demyelination, which may be due to rapid correction of hyponatremia, hyperglycaemia, hypokalemia and ketoacidosis.
Osmotic demyelination syndrome in endstage renal disease. He subsequently developed osmotic demyelination syndrome. Overly rapid correction of chronic 48 hours hyponatremia results in brain dehydration, rendering it susceptible to the osmotic demyelination syndrome. Plasmapheresis to treat osmotic demyelination syndrome from. Osmotic demyelination syndrome ods is an acute demyelination process that usually occurs several days following an osmotic stress. Apr 11, 2014 osmotic demyelination syndrome ods is an uncommon disorder, characterized by noninflammatory demyelination involving the pons and other areas of the central nervous system, which may occur for instance as a consequence of an overly rapid correction of hyponatraemia. Plasmapheresis to treat osmotic demyelination syndrome.
Minocycline prevents osmotic demyelination associated with. Osmotic demyelination syndrome is an acute demyelination process that usually occurs several days following an osmotic stress. Osmotic demyelination syndrome in children pediatric neurology. Osmotic demyelination syndrome following rapid correction. It typically occurs in areas of brain that are slowest to uptake osmolytes, which include central pons 3050%, extrapontine sites 2050% or both. Jul 01, 2018 osmotic demyelination syndrome due to hyperosmolar hyperglycemia. Clinical resolution of osmotic demyelination syndrome. Takanobu hirosawa, md and taro shimizu, md, mph, mba. Osmotic demyelination syndrome belongs to an entity known as pontine myelinolysis. Since osmotic demyelination syndrome is an iatrogenic disease its early recognition and. Since osmotic demyelination syndrome is an iatrogenic disease its early recognition and effective prevention is mandatory. Mar 20, 2019 osmotic demyelination syndrome ods is an acute demyelination process that usually occurs several days following an osmotic stress. Osmotic demyelination syndrome is a debilitating, potentially fatal disorder which includes two components central pontine myelinolysis cpm.
Osmotic demyelination syndrome following rapid correction of. With the possible exception of hyponatremia caused by heart failure or hepatic cirrhosis, a rapid. The condition manifested as acute severe parkinsonism, bilateral ptosis and gaze impairment. Role of risk factors in developing osmotic demyelination. We present a case of 52 year old male presenting with weakness and dysarthria with characteristic mri appearance 2.
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