Pdf extrapontine myelinolysis of osmotic demyelination. Osmotic demyelination syndrome definition of osmotic. Clinical and functional outcome and factors predicting. The mechanism of myelinolysis is thought to be linked to rupture of myelin sheaths which is caused by osmotic effects in the rapid correction of sodium levels. Osmotic demyelination syndrome ods and overly rapid correction of hyponatremia uptodate. Acute hyponatremia merits rapid correction to prevent brain herniation, but overtreatment of hyponatremia can lead to osmotic demyelination syndrome. It is important to identify patients at risk from osmotic demyelination 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. Finally, protein intake leads to an increased free water clearance in the. Many conditions including hormonal abnormality are associated with this syndrome. She was diagnosed as a case of osmotic demyelination syndrome ods formerly known as central pontine myelinolysis cpm which was confirmed by mri. Pdf we present a 40 year old man who was admitted to the hospital with convulsions. A symptomfree or stable clinical interval is then followed by. Osmotic demyelination syndrome ods, which embraces central pontine myelinolysis cpm and extrapontine myelinosis epm, is often underdiagnosed in clinical practice, but can be. Osmotic demyelination syndrome refers to acute demyelination seen in the setting of osmotic changes, typically with the rapid correction of hyponatremia. Atlas of renal pathology free core curriculum free. What is osmotic demyelination in hyponatremia and how is. Risk factors and outcomes of rapid correction of severe. We report a patient with severe hyponatraemia who developed osmotic demyelination syndrome.
Hameed raina 1, irfan yusuf wani 2 abstractpurpose. 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. Osmotic demyelination syndrome commonly affects the pons and infrequently involves the extrapontine region. A case of osmotic demyelination syndrome occurred after. Pdf on jul 8, 2014, christian bornke and others published osmotic. Case report osmotic demyelination syndrome following. Axial fatsaturated t2weighted image showing hyperintensity in the pons with sparing. Clinical resolution of osmotic demyelination syndrome. It is caused by the destruction of the layer myelin sheath covering nerve cells in the middle of the brainstem pons. Osmotic demyelination syndrome ods, which embraces central pontine.
Osmotic demyelination syndrome has also been reported in a cat and may have been due to poor nutrition. Complete recovery of chronic osmotic demyelination. He subsequently developed osmotic demyelination syndrome. The osmotic demyelination syndrome is a complication of treatment of patients with.
The osmotic demyelination syndrome ods has been a recognized complication of the rapid correction of hyponatremia for decades. However, in recent years, a variety of other medical conditions have. Since osmotic demyelination syndrome is an iatrogenic disease its early recognition and effective prevention. Osmotic demyelination syndrome following rapid correction of. Severe hyponatraemia carries a risk of cerebral oedema with a significant mortality, yet correcting it too rapidly can result in osmotic demyelination syndrome. His final diagnosis was osmotic demyelination syndrome ods.
Osmotic demyelination syndrome ods and overly rapid correction. Treatment response in osmotic demyelination syndrome. Minocycline prevents osmotic demyelination associated with. Treatment of severe hyponatremia american society of. Osmotic demyelination syndrome ods is also referred to as central pontine myelinolysis cpm. Central pontine myelinosis and osmotic demyelination syndrome. Role of risk factors in developing osmotic demyelination. Findings on t1weighted scans include a symmetric region of low signal involving the basilar. Oligodendrocytes are particularly sensitive for osmotic changes therefore changes that are seen with osmotic demyelination syndrome. Although it is recognised that osmotic demyelination syndrome is a rare disease, its dramatic clinical course points out the importance in different disciplines. Osmotic demyelination unrelated to hyponatremia american. 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. Osmotic demyelination syndrome ods is a lifethreatening demyelinating syndrome. Central pontine myelinolysis, also known as osmotic demyelination syndrome, is rare in renal transplant recipients, occurring more frequently after liver transplantation figure 331.
Depending on the severity and cause of hyponatremia, the treatment consists of. The pathophysiology of osmotic demyelination is controversial. Central pontine myelinolysis is a demyelinating disorder with characteristic magnetic resonance features. Diffusionweighted image has hyperintense signal, indicating restricted diffusion of free water in tissues at the site of osmotic demyelination d. Plasma exchange successfully treats central pontine. While they are very similar conditions, ods is slightly different. Osmotic demyelination syndrome, central pontine demyelination. Osmotic demyelination syndrome ods is a wellknown disorder caused by rapid correction of serum sodium. Pdf movement disorders and the osmotic demyelination. Osmotic demyelination syndrome presenting with chorea. Central pontine myelinolysis, or osmotic demyelination syndrome, is a neurological disease caused by severe damage of the myelin sheath of nerve cells in the brainstem, more precisely in the pons. Neurological deterioration following treatment for hyponatremia.
It is the more recent term replacing central pontine myelinolysis, recognizing that extrapontine structures can also be affected, previously known as extrapontine myelinolysis. Although the mechanism is not fully understood and the. The pathogenesis of osmotic demyelination syndrome is thought to be opposite to that. The aim of this study was to present and discuss previous cases and the pathophysiological mechanisms involved in ods secondary to hhs. The osmotic demyelination syndrome is an uncommon disorder. Some authors consider it impossible to establish a totally risk free level of. See overview of the treatment of hyponatremia in adults.
Osmotic demyelination syndrome ods, which embraces central pontine myelinolysis cpm and extrapontine myelinosis epm, is often underdiagnosed in clinical practice, but can be fatal. Osmotic demyelination syndrome ods predominantly occurs in the setting of. There are no proven effective therapies for ods, but we describe the first case showing. Kallakatta rn 2011 clinical and functional outcome and factors predicting prognosis in osmotic demyelination syndrome. Central pontine myelinolysis an overview sciencedirect. Following supportive treatment he made a full recovery. Pdf a case of osmotic demyelination syndrome occurred after the.
Osmotic demyelination syndrome following rapid correction. Central pontine myelinolysis lockedin syndrome youtube. Movement disorders and the osmotic demyelination syndrome. Avoid common mistakes when treating hyponatremia acp. It is important to identify patients at risk from osmotic demyelination syndrome and to correct their hyponatraemia appropriately. The extrapontine myelinolysis of osmotic demyelination syndrome ods is a wellknown but uncommon disorder of the central nervous system. 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. By continuing to browse this site you are agreeing to our use of cookies.
The incidence of ods in a postmortem series of alcoholics and liver transplant recipients. Osmotic demyelination syndrome radiology reference. Osmotic demyelination syndrome due to hyperosmolar. Chest postgraduate education corner emcrit project. A consecutive series of patients with osmotic demyelination syndrome. Bartley2 1 registrar in anaesthetics, university hospital of north tees, hardwick road. The knowledge of conditions associated with an increased risk of osmotic demyelination syndrome and careful management of osmotic disturbances according to current standards may contribute to. Osmotic demyelination syndrome is sufficiently common at sodium levels. Osmotic demyelination syndrome ods primarily occurs after rapid correction of severe hyponatremia. The association of ods with hyperosmolar hyperglycemic state hhs has been seldom reported. Osmotic demyelination syndrome ods is brain cell dysfunction. Hyperintense signal on diffusionweighted image arrow is a frequent but not constant finding in osmotic demyelination. Osmotic demyelination syndrome ods is an uncommon disorder, characterized by noninflammatory demyelination involving the pons and other areas of the central nervous system, which.
Case report osmotic demyelination syndrome following rapid correction of hyponatraemia d. The osmotic demyelination syndrome ods has been a recognized complication of the rapid correction of. Central pontine myelinolysis, paralysis, dysarthria, dysphagia, diplopia, loss of consciousness, locked in syndrome, axonal. This case report demonstrates that if serum sodium is re lowered early in the course of osmotic demyelination syndrome. Osmotic demyelination syndrome after correction of. Pdf osmotic demyelination syndrome ods may be observed as a result of a rapid change in serum osmolarity, such. Laureno and karp suggest that it may be impossible to define a level of correction that is always completely free of risk.
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