Osmotic demyelination syndrome

Osmotic demyelination syndrome is a condition that can occur if hyponatraemia is corrected too rapidly. It may consist of central pontine myelinolysis, extrapontine myelinolysis or both. 

Clinical features: 
  • Confusion 
  • Dysarthria 
  • Dysphagia 
  • Quadriparesis 
  • Coma 
  • Rarely seizures 
  • If EPM – movement disorders 

Clinical features may become apparent a few days after the rapid correction of sodium 

Osmotic demyelination syndrome is rare if initial sodium >120meq/l; mainly occurs if initial sodium is 105meq/l or less

It is more common in presence of 
  • Alcoholism 
  • Malnutrition 
  • Liver disease
  • Prolonged diuretic use 
  • Hypokalaemia 
  • an organ transplant 
  • Extensive burns 

Can be detected by T2-weighted MRI scan but changes may take several weeks to become radiologically apparent 

Treatment of osmotic demyelination syndrome is difficult – best to try and prevent 

Possible management includes steroids, IV IG, thyrotrophin releasing hormone, minocycline, relowering of serum sodium or plasmapheresis

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