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
