In this study the clinical and radiological features, etiological factors and clinical outcomes of patients diagnosed with osmotic demyelination syndrome (ODS). A total of 40 patients with clinical and radiological findings suggestive of ODS admitted in AIMS, Kochi from Jan 2009-sept 2012 were included in the study. The data from these patients were analysed. Out of 40 patients of ODS 17 patients had Extra pontine myelinolysis (EPM),16 patients had Combined extrapontine and Pontine myelinolysis (CEPM) and 7 had Central pontine myelinolysis (CPM). 23 patients were males and 17 were Females. Mean Age was 56.8 yrs. Hyponatremia was seen in 77.5% of study population. The most common cause for it was SIADH precipitated by infection mostly Urinary Tract Infection. 5 patients had evidence of Chronic Liver Disease and 6 were alcoholic. Clinical presentation was varied and included Altered Sensorium in 19 patients, Extrapyramidal state (18), Locked in state (7), Ataxia (7), Dysphagia, Dysarthia and Dystonia in 3 patients each. MRI showed involvement of Thalamus and internal capsule commonly apart from the involvement of pons and basal ganglia. Diffusion Restricting lesions were seen in 9 patients. MRI was normal in 2 patients. 22 patients were treated with steroids. Dopaminergic drugs were used in most of patients with extra pontine myelinolysis. Botulinum Toxin was used in 2 patients with intractable dystonia. On discharge from hospital 15 patients were bedridden and 18 patients were ambulant. 2 of our patients had succumbed to their illness. ODS is a rare demyelination syndrome. Prompt diagnosis and management is needed for favourable clinical outcome.