OSMOTIC DEMYELINATION SYNDROME IN UNUSUAL SETTINGS

Abstract

Objective: To highlight the occurrence of osmotic demyelination syndrome (ODS) in settings other than the classical ODS induced by rapid correction of hyponatremic states. The background, clinico- radiological features, treatment and outcome of eight ODS patients are discussed here. We encountered eight patients with ODS in Materials and Methods: uncommon clinical settings at the department of neurology, Government Stanley medical college hospital, Chennai between April 2017 to October 2018. Patients were evaluated, investigated, treated and outcome was assessed. Results: Eight patients in the age group 22 to 60 years had ODS. The clinical presentations were diverse. Akinetic mutism was the commonest presenting feature of ODS. Four out of eight patients had hyperglycemia out of which three had diabetic ketoacidosis (DKA) and one was in hyperglycemic hyperosmolar state (HHS). Two patients with chronic kidney disease (CKD) developed myelinolysis following hemodialysis. One patient each in post liver transplant state and following alcohol binge were diagnosed with ODS. Serum sodium levels were in normal range and there was no undue fluctuation in all. Four had central pontine myelinolysis (CPM), three had Extrapontine myelinolysis (EPM) and one had both in Magnetic Resonance Imaging (MRI) of Brain. Background illnesses were addressed. Five patients were independent with mRS of 1 and one patient had mRS of 2 at the end of 3 months and two CKD patients succumbed due to disease per se. ODS commonly occurs in the setting of rapid correction of hyponatremia especially in chronic Conclusion: alcoholics and debilitated individuals. We have described myelinolysis in diabetic ketoacidosis, hyperglycemic hyperosmolar state, Renal failure following dialysis, post liver transplant and alcohol binge drinking where there were no undue fluctuation in sodium levels. The prognosis is variable and also depends on presence of secondary complications like deep venous thrombosis, sepsis and aspiration pneumonitis.