Abstract
Osmotic demyelination syndrome primarily occurs due to an imbalance of serum electrolytes and caused by rapid correction of hyponatremia. Isolated extrapontine myelinolysis is extremely rare, etiopathogenesis of which may be related to osmotic stress resulting from electrolyte disequilibrium. Extrapontine sites involved in osmotic demyelination syndrome show abundant oligodendrocytes, which are highly susceptible to osmotic stresses. Myelin vacuolization followed by intramyelinic splitting and disruption of myelin sheaths occur due to rapid osmolar fluctuations. Symmetrical hyperintensities showing restriction, which resolve in subsequent magnetic resonance scans can help in clinching the diagnosis of this condition in a given clinical setting.
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