Abstract
Hyponatremia is a common medical problem often found in the elderly and is due to poor intake, medical comorbidities, and medications. Central to the management of this condition is the use of normal and hypertonic saline, besides the use of supplementary salt in diet and limited water intake. However, correction has to be slow; this depends upon whether the patient has acute or chronic hyponatremia. Rapid correction produces a myriad of clinical manifestations, commonly called as osmotic demyelination syndrome. The demyelination is pyramidal in most instances; the basis pontis is usually the frequent location. Extrapyramidal demyelination occurs in 10% of cases. Here, we present a form of extrapyramidal demyelination (i.e. secondary parkinsonism) secondary to osmotic demyelination syndrome, which has rarely been reported in the literature.
Highlights
Osmotic demyelination syndrome (ODS) is a complication of rapid correction of hyponatremia that occurs as a result of cellular edema, which is caused by fluctuating osmotic forces, resulting in compression of fiber tracts causing demyelination
During the period of hyponatremia, the concentration of intracellular charged protein moieties is altered; reversal cannot parallel a rapid correction of electrolyte status
The patient was conscious and oriented to time, place, Discussion Extrapontine myelinolysis (EPM) occurs in 10% of cases of ODS secondary to rapid correction of hyponatremia
Summary
Osmotic demyelination syndrome (ODS) is a complication of rapid correction of hyponatremia that occurs as a result of cellular edema, which is caused by fluctuating osmotic forces, resulting in compression of fiber tracts causing demyelination. MRI of the brain revealed hypointense signals in the pons and the basal ganglia on T1 (Fig. 1) and hyperintense signals on T2 images (Figs 2 and 3) suggestive of demyelination. The patient was conscious and oriented to time, place, Discussion Extrapontine myelinolysis (EPM) occurs in 10% of cases of ODS secondary to rapid correction of hyponatremia. Central pontine myelinolysis and EPM are the same disease, sharing the same pathology, associations, and. Bilateral hyperintense lesions in the basal ganglia on T2 images
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