February 8, 2016: Osmotic demyelination syndrome

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February 8, 2016

Osmotic demyelination syndrome

Osmotic demyelination syndrome is an acute demyelination seen with rapid osmotic changes. It most commonly involves the pons but extrapontine myelolytic foci can be found in deep cerebral white matter with or without pontine involvement. Observed symptoms include acute paralysis, dysphagia, dysarthria, and other brainstem signs. In addition to rapid correction of hyponatremia, osmotic demyelination can occur with rapid changes in serum osmolality without sodium abnormalities. Risk factors include chronic alcoholism, hypokalemia, chronic renal failure on dialysis, liver failure, advanced cancer, and severe burns, especially in children.

  1. Singh TD, Fugate JE, Rabinstein AA. Central pontine and extrapontine myelinolysis: a systematic review. Eur J Neurol 2014; 21: 1443-1450.
  2. Burns JD, Kosa SC, Wijdicks EF. Central pontine myelinolysis in a patient with hyperosmolar hyperglycemia and consistently normal serum sodium. Neurocrit Care 2009; 11: 251-254.

Submitted by Yulia Orlova, M.D. Resident physician, RWJMS at Rutgers University, New Brunswick, NJ.

Disclosures: Dr. Orlova reports no disclosures.

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