Osmotic demyelination syndrome after bone marrow transplantation

Fatemeh Yaghoubi,Davood Babakhani,Farnoosh Tavakoli,Farnaz Tavakoli

doi:10.34172/jnp.2022.10

Abstract

A 14-year-old boy with a past medical history of bone marrow transplantation (BMT) was referred to the emergency department with the loss of consciousness and seizure. On admission, the blood test indicated strict hyponatremia with hypokalemia, hypomagnesemia, hypophosphatemia, hypoglycemia, and low-serum low-density lipoprotein cholesterol (LDL-C). After six days, the patient suffered from dysarthria, dysphagia, behavioral disturbances, disorientation, and obtundation. Based on the physical examination, hyperreflexia and upward bilateral plantar reflexes were outstanding. Lumbar puncture, spiral brain CT scan, and MRI were normal. Hence, MRI repeated 2 weeks later, and the T2-weighted image indicated the bilateral symmetric hyperintense lesions in the basal ganglia. The osmotic demyelination syndrome (ODS) is a scarce and serious neurologic complication of the quick correction of chronic strict hyponatremia.

Highlights

Implication for health policy/practice/research/medical education: Osmotic demyelination syndrome risk is highest in the patients with serum sodium of ≤120 mEq/L, especially if hyponatremia is associated with hypokalemia, low-plasma osmolality and other electrolyte disorders
Hyponatremia is one of the most common electrolyte abnormalities in patients referred to the hospital
Involving hypoglycemia, hypokalemia, hypophosphatemia, and hypomagnesemia may disrupt the normal activity of active transport pumps at the cell membrane included in the regulation of intracellular osmolarity, restricting the ability of brain to respond to osmotic stress [17]

Summary

Introduction

Hyponatremia is one of the most common electrolyte abnormalities in patients referred to the hospital. Considering CVID about 6 weeks ago, he had undergone bone marrow transplantation (BMT). He took some medications, involving cyclosporine, acyclovir, risperidone, citalopram, mesalamine, voriconazole, and prednisolone. The blood test indicated strict hyponatremia (serum Na:115meq/L) with hypokalemia (K: 3.1 meq/L), hypomagnesemia (Mg: 1 mg/dL), hypophosphatemia (Ph: 1.3 mg/dL), hypoglycemia (BS: 55 mg/dL) and low-serum LDL-C (LDL-C: 40 mg/dL). MRI repeated 2 weeks later, and T2-weighted image indicated the bilateral symmetric hyperintense lesions in basal ganglia (Figure 1). His neurologic abnormalities in MRI relatively recovered about two months later (Figure 2)

Discussion

Conclusion