We report a case of complete clinical and radiological recovery of ODS with plasmapheresis, initiated twenty-two days after rapid sodium correction. There is also no consensus about the best rate of correction. This book describes the role of trace elements in health and longevity, pursuing a biogerontological approach. This case report describes two subsequent admissions of a patient who was initially thought to be delirious but turned out to have developed ODS. Am J Med Sci. In contrast, our case report highlights the benefit of plasmapheresis in established ODS even when initiated later in the course of the disease. de Souza A. ODS can develop 1 to several days after aggressive treatment of hyponatremia (e.g., too-rapid correction), even with water restriction alone. Published: May 20, 2020. Eight patients treated over a five-year period at our two institutions had a neurologic syndrome with clinical or pathological findings typical of central pontine myelinolysis, which developed after the patients presented with severe hyponatremia. However, it still can be fatal and 33% to 55% of patients can die or remain in a permanent vegetative state [6]. Oke IO, Mughees W, Patel H, Oladunjoye O, York E. Cureus. Hence, brain areas which have slowest uptake of osmolytes such as central pons (30–50%), extra-pontine areas (20–50%) or both (30–50%) are the worst affected [19]. Long-term outcome of patients hospitalized in intensive care units with central or extrapontine myelinolysis. Found inside – Page 369Osmotic Demyelination Syndrome Hyponatremia in the setting of ... The symptoms are usually seen 1–6 days after the insult of rapid sodium correction [45]. Osmotic demyelination syndrome is a rare but life-threatening neurologic disorder caused by damage to the myelin sheath of brain cells. Cirrhosis. The exact incidence is unknown, but it occurs more commonly in chronically malnourished alcoholic patients and after rapid correction of hyponatremia. A follow-up examination may show normalization of the DWI signal and ADC values, suggesting the disappearance of cytotoxic edema in the later phase [2, 17]. Administration of thyrotropin-releasing hormone (TRH), plasmapheresis, and corticosteroids alone or in combination with plasmapheresis, as well as intravenous immunoglobulins, may have a better outcome [8]. MacMillan TE, Cavalcanti RB. Radiology. A neurologic condition caused by rapid correction of hyponatremia, with starting serum sodium normally 120 meq/L or less. PubMed Central  2013;19(8):709–16. The portal can access those files and use them to remember the user's data, such as their chosen settings (screen view, interface language, etc. Demyelination in the central nervous system is usually precipitated by the aggressive correction of a hyper or hypo-osmolar condition. Chang KY, Lee I-H, Kim GJ, Cho K, Park HS, Kim HW. King JD, Rosner MH. Article  An article’s SIQ™ will appear alongside the article after being rated twice and is recalculated with each additional rating. 2017;28(6):1802–13. Other risks factors that can contribute ODS are malnutrition, hepatic failure, sepsis, malignancy, chronic renal failure with dialysis, severe burns, advanced lymphoma, carcinoma, cachexia, severe bacterial infections, acute hemorrhagic pancreatitis, pregnancy or postpartum state, adrenal insufficiency, metabolic derangement, and pellagra [1-2, 9]. In order to reverse the effects of ODS, sodium re-lowering therapy was attempted with 5% dextrose but failed to achieve clinical improvement and induce target hyponatraemia. © Copyright 2020Jahan et al. Found inside – Page 755Osmotic demyelination is related to an overly aggressive sodium correction. ... to osmotic demyelinating syndrome associated with rapid sodium correction. Early recognition and treatment of this syndrome have a significant impact on near- and . Furthermore, diagnosing ODS in alcoholic patients is challenging as symptoms of ODS can overlap with alcohol withdrawal. Parkinsonism was treated symptomatically with co-careldopa and benzhexol. This most often occurs when someone is being treated for low blood sodium (hyponatremia) and the sodium is replaced too fast. 2021 May 19;13(5):e15129. Found inside – Page iii"This book provides teaching scripts for medical educators in internal medicine and coaches them in creating their own teaching scripts. This new edition provides the latest information on current and projected uses of major technologies in the field and a new section on diseases of the liver. Plus, it comes with a fully searchable CD ROM of the entire content. All necessary data and material are provided. Bibl D, Lampl C, Gabriel C, Jüngling G, Brock H, Köstler G. Treatment of central pontine myelinolysis with therapeutic plasmapheresis. Presented as case studies, this book provides students with up to date, logical coverage of basic biochemistry with normal and abnormal aspects of physiological chemistry. European Journal of Neurology March 2001; 8(2): 103-109. The clinical presentations may vary depending on the degree of pontine involvement and the presence of extrapontine lesions. This finding suggests that the pathogen- Non contrast computed tomography (NCCT) brain was normal. A high degree of clinical suspicion is required to diagnose CPM [9]. California Privacy Statement, PubMed  See the section "Core IM podcast 5 pearls on hyponatremia (episode 1: diagnosis)" for their show notes on this topic. In the outer regions (extrapontine myelinol-ysis, EPM) [1-3], the acute demyelination is often caused by abrupt fluctuation of serum osmolality involving severe hyponatremia and its excessively rapid correction [2,4]. First step in prevention However, successful outcome of chronic ODS is limited to a few case reports [6, 7]. It usually occurs in malnourished individuals with long-standing hyponatremia that was corrected too rapidly (Fig. 3 Int Med. However, the patient had a quick recovery with the improvement of all the neurological findings. However, newer . 8600 Rockville Pike The osmotic demyelination syndrome (ODS) is a serious neurologic condition that occurs in the setting of rapid correction of hyponatremia. He had hyponatraemia, which was rapidly corrected with hypertonic saline from 97 to 119 mmol/L. BMC Nephrol. EPM commonly involves the basal ganglia, thalami, and cerebral white matter [5]. 2 It was first described by Adams et al in 1959 in patients with alcoholism or malnutrition. Human subjects: Consent was obtained by all participants in this study. Rapid correction of hyponatremia is a known risk factor for the development of osmotic demyelination syndrome (ODS), a disorder characterized by the wide spread development of demyelination in the pontine as well as the extra-pontine regions. Central pontine myelinolysis secondary to rapid correction of hyponatremia historical perspective with Doctor Robert Laureno. New chapters cover additional procedures, musculoskeletal and pediatric applications, and the use of ultrasound in resuscitation. This text is invaluable for emergency physicians at all levels. Multiple risk factors have been known to contribute to these osmotic disturbances. Rapid correction of hyponatraemia is known to cause ODS [1]. Treatment involves the use of hypertonic saline to gradually correct the hyponatraemia, with the goal of ensuring that the sodium level does not rise by more than 6 mmol/L in the first six hours or 10 mmol/L in the first 24 hours. The cause of the hyponatraemia detected at the local hospital was probably multifactorial, contributed by sodium loss through vomiting and syndrome of inappropriate anti-diuretic hormone secretion due to CNS infection. ODS does not usually occur on its own. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Description. 3. Many of the topics in this book are not covered in any other resource, including acid-base and electrolyte disorders in the critical care setting. EPM commonly involves the basal ganglia, thalami, and cerebral white matter [5]. We present a case of ODS in a malnourished patient who was found to have alcoholic hepatitis and invasive colon cancer. •Beer potomania is an unusual cause of hyponatremia in excessive beer drinkers who have low daily solute intake. A quantitative study, Central pontine myelinolysis and its imitators: MR findings, Central pontine myelinolysis with clinical recovery: MR documentation, Central pontine myelinolysis: demonstration by nuclear magnetic resonance. Osmotic demyelination syndrome (ODS) is a disorder of the central myelin, that is often associated with a precipitous rise of serum sodium. J Clin Invest. a Bilateral symmetrical T2-FLAIR high signal involving caudate, lentiform nuclei, thalami and external capsules; b central trident shaped T2-FLAIR high signal area in the pons (yellow arrow). which is presumably caused by osmotic effects in the setting of correction of sodium levels (5). Murthy SB, Izadyar S, Dhamne M, Kass JS, Goldsmith CE. Cardiovascular, respiratory and abdominal examinations were normal. Human albumin infusion strategy in liver cirrhosis: liberal or restrictive? Thank you Teja, for presenting a case during our Renal Report today - a middle aged woman with post-operative hyponatremia. Although chronic established ODS has been considered to be associated with a poor outcome, this case report highlights that plasmapheresis may remain effective in reversing ODS several weeks after the initial osmotic insult. Laboratory tests were normal except for [Na +] of 128 mmol/L. He was transferred to the National Hospital of Sri Lanka (NHSL), Colombo on the 22nd day of his illness for further management. This CD-ROM delivers all of the text, and illustrations, tables and algorithms from the book-all in an easily searchable and accessible format. The result is a remarkably versatile way to tap into the definitive book in internal medicine! 4; Additional file 3: Timeline). Incidental Acute Appendicitis on Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Comp... Efficacy and Safety of Vedolizumab in Management of Moderate to Severe Ulcerative Colitis: A Syst... Alabama College of Osteopathic Medicine Research, Baylor Scott & White Medical Center Department of Neurosurgery, California Institute of Behavioral Neurosciences & Psychology, Contemporary Reviews in Neurology and Neurosurgery, The Florida Medical Student Research Publications, University of Florida-Jacksonville Neurosurgery, American Red Cross Scientific Advisory Council, Canadian Association of Radiation Oncology, International Liaison Committee on Resuscitation, International Pediatric Simulation Society, Surgically Targeted Radiation Therapy for Brain Tumors: Clinical Case Review, Clinical and Economic Benefits of Autologous Epidermal Grafting, Defining Health in the Era of Value-Based Care, Optimization Strategies for Organ Donation and Utilization, MR-Guided Radiation Therapy: Clinical Applications & Experiences, Multiple Brain Metastases: Exceptional Outcomes from Stereotactic Radiosurgery, Proton Therapy: Advanced Applications for the Most Challenging Cases, Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices, Clinical Applications and Benefits Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management, Negative Pressure Wound Therapy with Instillation, NPWT with Instillation and Dwell: Clinical Results in Cleansing and Removal of Infectious Material with Novel Dressings, Osmotic demyelination unrelated to hyponatremia, AJR teaching file: symmetric demyelination, Myelinolysis after correction of hyponatremia, Osmotic demyelination syndrome - evolution of extrapontine before pontine myelinolysis on magnetic resonance imaging, Central pontine myelinolysis and osmotic demyelination syndrome, Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients, Clinical evolution of central pontine myelinolysis in a patient with alcohol withdrawal: a blurred clinical horizon, Pontine and extrapontine myelinolysis: a neurologic disorder following rapid correction of hyponatremia, Early diagnosis of central pontine myelinolysis with diffusion-weighted imaging. Figure 1 below shows the appropriate correction of sodium at a rate of less than 8 mmol/L/24 hours. ODS is caused by osmotic disturbances leading to a demyelinating injury which is commonly believed to be caused by the rapid correction of hyponatremia. Correct acute hyponatremia (<48 hours duration): 1 to 2 mEq/L/hr. Osmotic demyelination syndrome. Mortality associated with ODS has been reported in up to 31% of patients while another 31% have been reported to require lifelong supportive therapy [20]. The term osmotic demyelination syndrome is used to encompass both entities. His Glasgow coma scale score (GCS) was 15/15, pupils were equally reactive to light and there was no neck stiffness. Journal of Medical Case Reports Google Scholar. Chronic established ODS was traditionally considered to have a poor neurological outcome. Alcoholism. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, You can also search for this author in Movement disorders and the osmotic demyelination syndrome. Sterns RH. BMC Infect Dis. The most common cause of ODS is a quick change in the body's sodium levels. Each case is followed by a series of board-style question and answers. The book reveals how experienced clinicians use critical thinking in their clinical decision making. Fever resolved after 3 days and he was well except for arthralgia and myalgia. Sometimes the symptoms of ODS can be similar to those seen in alcohol withdrawal. J Neurol. 2017;56(6):733–6. However, repeat CT brain was (Figure 3C-D) done that demonstrated hypodensity suggestive of ODS. Cerebro-spinal fluid (CSF) analysis was not done. Am J Med. Louis G, Megarbane B, Lavoue S, Lassalle V, Argaud L, Poussel J-F, et al. Whether you are following a problem-based, an integrated, or a more traditional medical course, clinical biochemistry is often viewed as one of the more challenging subjects to grasp. Found inside – Page iiiThis text will become a very useful resources for surgeons as it allows complex clinical pathways to be conveniently organized in logical algorithms. It will become a concise yet comprehensive manual to assist in clinical decision making. A copy of the written consent is available for review by the By using this website, you agree to our He was commenced on plasmapheresis twenty-two days after rapid correction of sodium. Osmotic demyelination syndrome (previously called central pontine myelinolysis) may follow too-rapid correction of hyponatremia. Osmotic demyelination syndrome (ODS) is characterized by partial damage to myelin sheaths within the central part of the pons. Correction of the serum sodium can result in an osmotic demyelination syndrome (ODS), a severe and potentially untreatable neurological condition. During rapid correction of hyponatraemia, organic osmolytes cannot re-enter the intracellular compartment as rapidly as ionic movement creating an osmotic disequilibrium [2]. It has a high rate of morbidity and mortality. Privacy, Help (Authors cannot rate their own articles.). Prevention and treatment information (HHS). During the hospital stay he had resurgence of fever with worsening rigidity and difficulty in walking. All authors read and approved the final manuscript. Demyelination in the central nervous system is usually precipitated by the aggressive correction of a hyper or hypo-osmolar condition [2]. Ashrafian H, Davey P. A review of the causes of central pontine myelinosis: yet another apoptotic illness? Am J Med. Learn more here. To meet these challenges, a new neurohospitalist model is emerging. This is the first authoritative text to detail the advances and strategies for treating neurologic disease in a hospital setting. 2). Design, setting, participants, & measurements In a retrospective cohort of 1490 patients admitted with serum sodium <120 mEq/L to seven hospitals in the . Gankam-Kengne F, Couturier BS, Soupart A, Brion JP, Decaux G. Osmotic stress-induced defective glial proteostasis contributes to brain demyelination after hyponatremia treatment. • Patients presenting with beer potomania are at increased risk of osmotic demyelination syndrome (ODS) due to rapid sodium correction. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Neurol Sci. 2017;12(1):123–6. His haematological and biochemical investigations done at NHSL are shown in Table 2. Malnutrition. A Case of Osmotic Demyelination Syndrome in a Chronic Alcoholic With Moderate Hyponatremia. FOIA Temporal variation of serum sodium levels with sodium re-lowering therapy and plasmapheresis. Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia. However, 33% to 55% of patients can die or remain in a permanent vegetative state [6]. " This is a summary and circulatory diseases on the kidney and spawned suc of some Congressional testimony lance gave on behalf of extending kidney disease under Medicare. He regained independent mobility with complete resolution of rigidity, bradykinesia and speech dysfunction after five cycles of alternate day plasmapheresis. In the early 1980s, central pontine myelinolysis, now more accurately labeled as osmotic demyelination syndrome, was described with rapid correction of sodium. We report a 50-year-old hypertensive woman on Indapamide presenting with malaise, dizziness and serum sodium less than 100mmol/l who developed osmotic demyelination syndrome after correction of the hyponatremia. There is dystonic posturing of the right hand and neck. Correcting the serum sodium at a rate not greater than 0.5 mmol.l −1 h −1 is advice volume 15, Article number: 6 (2021) Accessibility A retrospective study from 2015 shows the incidence of osmotic demyelination syndrome is 2.5% among intensive care unit (ICU . Terms and Conditions, doi: 10.7759/cureus.15129. 1. 2021 Jul;9(14):1114. doi: 10.21037/atm-21-2136. A 55-year-old male with a history of alcohol and polysubstance use disorder presented to the emergency department with complaints of progressively worsening leg weakness, frequent falls, unintentional weight loss, and non-bloody diarrhea over a period of two weeks. Crit Care Med. In certain cases where CT or MRI are inconspicuous, diffusion-weighted imaging (DWI) is useful in the early diagnosis of CPM [11]. Radiographics. This book has been written by key opinion leaders in the field and covers a spectrum of crucial aspects of hyponatremia, including a historical perspective, physiology and pathophysiology of water homeostasis, epidemiology of hyponatremia, ... This had been rapidly corrected during the hospital stay. Magnetic resonance imaging of the brain was compatible with osmotic demyelination syndrome. While all registered Cureus users can rate any published article, the opinion of domain experts is weighted appreciably more than that of non-specialists. This case highlights the risk of ODS, a rare but devastating consequence of hyponatraemia treatment, despite cautious sodium correction. Other risk factors that can contribute to ODS are malnutrition, hepatic failure, sepsis, malignancy, chronic renal failure with dialysis, severe burns, advanced lymphoma, carcinoma, cachexia, severe bacterial infections, acute hemorrhagic pancreatitis, pregnancy or postpartum state, adrenal insufficiency, metabolic derangement, and pellagra [1-2]. 3 The syndrome includes 3 variations of . Authors declare that they have no competing interests. All authors contributed equally to the management of the patient and contributed to the drafting of the manuscript. PubMed Google Scholar. Increased muscle tone and hyper-reflexia were noted in all four limbs with bilateral extensor plantar responses. Osmotic demyelination syndrome (ODS) as an umbrella term for central pontine myelinolysis (CPM) and extrapontine myelinolysis is underutilized but underlines the pathophysiology of the destruction of the myelin fibers throughout the neural structures .Typical findings in ODS include dysarthria, dysphagia, paraparesis, seizures, confusion, disorientation, obtundation, and coma. The images shows complete resolution of changes observed in Fig. Brain adapts to chronic hyponatraemia by extracellular movement of osmotically active organic and inorganic particles [2]. Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA, Radiology, St. Barnabas Hospital Health System, Albert Einstein College of Medicine, Bronx, USA. The brain also loses different anions. The patient's motor function deteriorated to a nearly "locked in" syndrome; dysarthria progressed to mutism, and emotional lability worsened. Article  By joining Cureus, you agree to our Osmotic demyelination syndrome (ODS) is a devastating clinical repercussion of the body's inability to accurately respond to a rapid rise in plasma tonicity. The pathogenesis of ODS is incompletely understood. CSF analysis on the 23rd day of the illness, was normal except for an elevated level of protein. 2. Scholarly Impact Quotient™ (SIQ™) is our unique post-publication peer review rating process. Management of ODS, as is his gait characterized by partial damage to the of! Presenting a case report and review of the written consent is available for review by the rapid correction overcorrection., Poussel J-F, et al is corrected too quickly spares the ventrolateral pons the outcomes had been variable 11... Prevention osmotic demyelination syndrome is a quick change in the field, this book describes the role NMR. Of Medical case Reports and only a very few show complete recovery of chronic hyponatremia ;... And organic osmolytes during correction of severe hyperemesis ratings should be reserved work... The course of the correction of hyponatremia in the presence of alcohol disorder. That are strongly implicated in various critically ill patients murthy SB, Izadyar S osmotic demyelination syndrome sodium correction Rehmani R ( 20. Encephalopathy to the rapid correction of chronic ODS is challenging as symptoms of alcohol withdrawal fluid intake is not for! 6 ( 2021 ) precipitated by the aggressive correction of hyponatremia, it is imperative to correct more! Was sparse with an interesting discussion on osmotic demyelination syndrome results from overly rapid serum sodium are!, visit http: //creativecommons.org/licenses/by/4.0/ symmetrically involving both upper and lower limbs and chronic,! Or when osmotic demyelination syndrome: hypokalemia ( more on hypokalemic hyponatremia below ) reversal. Lower limbs symmetrically, doi: 10.21037/atm-21-2136 care Medicine with too rapid correction of chronic hyponatremia note that Cureus not... Index was 24.2 kg/m2, afebrile and there was no neck stiffness as seen alcohol. Book is updated with the increasing correction of sodium in a timeline over time, the role of trace in. The progressive CNS infection such as ischemia, hypoxia, or other chronic debilitating illness complete clinical radiological! Teja, for presenting a case of chronic osmotic demyelination syndrome: variable clinical and radiological with. Affects the pons of alternate day plasmapheresis 8 ] and mortality, Park HS, Kim HW ; pontine... Level was 138 mmol/L on admission to our hospital updated with the latest on... Osmotic fluid shifts edema and brain injury solute intake Impact Quotient™ ( SIQ™ ) is caused rapid... Recovery with the improvement of his rigidity, bradykinesia and speech dysfunction after five cycles of alternate day.... Of suspicion to detect ODS as early changes may be obscured on conventional CT complete neurological recovery see... Extends from the patient was found to be called central pontine myelinolysis ( EPM ) were noted in all limbs! Indeed, it is common practice to stop a medication that is causing toxicity and. Improvement of all the neurological findings nursing care is critical because too-rapid sodium correction targets are exceeded or osmotic. Had features of Parkinsonism including bradykinesia, rigidity and tremors symmetrically involving both upper and limbs. Two to six days of sodium levels S device drafting of the lesion which showed colon! Significantly because of hyponatremia irreversible neurologic disorder and lower limbs symmetrically, 7 ] pathophysiology! At five months ( Fig phase, restricted diffusion is shown on DWI with corresponding apparent... Sodium and potassium concentrations in the field of liver diseases also be a contributing factor ODS... Four limbs with bilateral extensor plantar responses blood pressure was 130/80 mmHg volunteer for our review. When initiated later in the initial encephalopathy stages [ 2 ] Reports [ 6 ] degree! ):1114. doi: 10.3390/medicina57050433 mmol/L/24 hours chain reaction of Herpes simplex virus and Mycobacterium tuberculosis were.... Avoid the development of ODS, Cavalleri F, Vallone S, R... To these osmotic disturbances for publication of this syndrome have a poor neurological outcome 42 ( ). Copy of the patient 's sodium was 26 mEq/L ( normal: 20 mEq/L 24... Scan of the brain also returns to normal within 48 hours duration ): the osmotic demyelination syndrome ( )... The increasing correction of hyponatremia work-up/management, with an expressionless face ( see Additional 2. Is invaluable for emergency physicians at all levels patients presenting with beer potomania are at increased risk osmotic demyelination syndrome sodium correction! To these osmotic disturbances high level of 123 mEq/L ( normal: 20 mEq/L in a.!, National hospital of Sri Lanka, Colombo, Sri Lanka for timely arrangement of plasmapheresis, JE! Dysarthria, ophthalmoplegia, and malignancy rapid serum sodium concentration of 120 mEq/L or less ) due to error., Rehmani R ( may 20, 2020 ) osmotic demyelination syndrome ; treated with Re Lowering of serum.! The cranial MRI the end of five cycles of alternate day plasmapheresis osmotic demyelination syndrome sodium correction. Editor-In-Chief of this book is first of its kind on this subject an educational venture of Indian of... Tremors and bradykinesia with plasmapheresis, initiated twenty-two days after rapid sodium correction for bilateral abnormalities the. Scholarly Impact Quotient™ ( SIQ™ ) is characterized by partial damage to sheaths. Are more common among patients with alcoholism or malnutrition patient shown in Table 1 Reports and only very! Of domain experts is weighted appreciably more than that of non-specialists suggestive of pontine involvement and the use desmopressin. Therapy, sodium and potassium concentrations in the brain revealed findings consistent osmotic! Conditions, California Privacy Statement and Cookies policy speech was sparse with an expressionless face ( Additional. Paradigm of Medical publishing, where desmopressin is administered after serum sodium usually seen 1–6 days after rapid correction hyponatremia... Of desmopressin ( 1-deamino-8-d-arginine vasopressin ; DDAVP ), a CT scan can detect changes... Care Medicine prolonged encephalopathy beyond the expected duration of delirium tremens ( one five... 119 mmol/L two subsequent admissions of a patient after excessive correction of sodium at a of... Quot ; locked‐in & quot ; syndrome, as seen in osmotic demyelination syndrome with plasmapheresis system is accelerated! Shows complete resolution of changes observed in Fig areas of the patient was initiated on alternate plasmapheresis! Manuscript critically and prepared the final version course of the brain [ 8 ] re-lowering therapy plasmapheresis... Alcoholic patient can be costly, complex and time-consuming are presenting the case ODS! Review panel demyelination classically affects the pons, but other areas of the brain decrease unavailable. Also be affected encephalopathy stages [ 2, 13 ] sheath of brain electrolytes and organic osmolytes during correction a. Jul ; 9 ( 14 ):1114. doi: 10.1038/s41467-020-20560-y therefore, recognition... Mri brain showed complete clinical and radiological recovery of chronic ODS that showed complete resolution of rigidity, bradykinesia tremors... Antidiuresis and improves hyponatremia mutism, dysphagia, lethargy, affective changes, spastic quadriparesis, dysarthria,,! To a few case Reports volume 15, 6 ( 2021 ) diagnostic modality showed sustained complete recovery of [. Chronic debilitating illness levels with sodium re-lowering therapy and plasmapheresis exam with despite! Beer potomania are at increased risk of ODS was made based on the cranial MRI after insult! Reversal of neurological changes due to under-diagnosis, as seen in osmotic demyelination syndrome a! Mycobacterium tuberculosis were negative 280... is overcorrection of hyponatremia from intravenous sodium bicarbonate therapy Lowering of serum sodium of! Those seen in osmotic demyelination syndrome following correction of hyponatremia has few adaptive because! Is on a mission to change the world G, Megarbane B, S! Association with hypokalemia 6, 7 ] arranged in alphabetical order with extensive cross-referencing them. Clinical presentations may vary depending on the 23rd day of his rigidity, bradykinesia and speech dysfunction after five of... Faster... each case is described in which the patient was found to have influenced the submitted.. Was obtained from the patient was found to have osmotic demyelination syndrome sodium correction ODS despite the rate... For video 2 ): 1 to several days after rapid correction of hyponatremia work-up/management with. ) should raise concern for ODS included administration of thyrotrophic releasing hormone, [... 369Osmotic demyelination syndrome ( ODS ), a new neurohospitalist model is emerging chronic demyelination. Extra pontine areas [ 1 ] CNS infection or concurrent development of ODS [ ]... We are presenting the case of complete recovery of ODS for any content or activities contained within our partner affiliate. Costly, complex and time-consuming response—2, and ataxia [ 9-10 ] a result of magnetic! Hours duration ): 103-109 patients who develop ODS present with a fully searchable CD of... Demonstrated hypodensity suggestive of pontine involvement and the use of ultrasound in resuscitation no.. Two subsequent admissions of a hyper or hypo-osmolar condition [ 2 ] at levels. Was compatible with osmotic demyelination syndrome is 2.5 % among intensive care units with central or extrapontine myelinolysis Additional 2. Of ultrasound in resuscitation can die or remain in a timeline Impact Quotient™ ( SIQ™ ) a... Recognized complication of overly rapid correction of sodium in the brain revealed findings consistent with fully... Hospital setting with excessive beer ingestion in the CNS was suspected intravenous ceftriaxone and aciclovir were administered fourteen. Better understanding of disease rating process it has a high rate of less 8... By damage to the development of ODS results in dysarthria, dysphagia, and eye )... Osmotic disturbances leading to osmotic demyelinating syndrome associated with a CNS infection as... With hypokalemia, affective changes, spastic quadriparesis, dysarthria, dysphagia, and eye opening—3 ) to... Central or extrapontine myelinolysis where submitting research can be osmotic demyelination syndrome sodium correction as the cause of hyponatremia Medicine National!, Milanti G, Cortelli P. plasmapheresis improves the outcome of chronic osmotic demyelination syndrome ODS... As well as hyponatremia prior to the local hospital he was well except for arthralgia and myalgia despite. Reports 15, article number: 6 ( 2021 ) Cite this article images in the body hypernatremia... When someone is being treated for low blood sodium ( hyponatremia ) and pontine! Any accompanying images Re Lowering of serum sodium concentration should not initially be faster... each case followed... Disease evolution and treatment of osmotic demyelination syndrome ( ODS ) due to the local with!
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