Pontine Myelinolysis Research Articles

Prediction quality of patients’ composited outcomes of interest and how much variations on the outcomes explained by the patients’ sodium levels

Background: Hypernatremia can be caused by medications, glucose/urea-related hyperosmolarity, overdiuresis, compartmental fluid distribution imbalances, iatrogenic hypertonic saline excess, renal concentrating performance defects, overdiuresis, and hypermetabolic states. Patients who are in critical condition, encompassing ailments of the heart, liver, lungs, brain, and kidneys, frequently manifest hyponatremia (sodium < 135 mEq/L). Similar to hypernatremia, hyponatremia signifies the severity of the illness and a bleak prognosis. Hyponatremia is less lethal than central pontine myelinolysis, which overcorrects sodium concentrations urgently. Aim: The objective of this research endeavour was to investigate the strength of correlations, the extent to which the independent variables account for the overall variability in the dependent variable, and the accuracy of the dependent variable's predictions. In addition, the purpose of this test was to extract the coefficients required to present the Binary Logistic Regression models that were investigated. Methods: Between May 2018 and May 2021, this study examined two Na-based prognosticators for overall mortality in critically ill patients admitted to the King Hussein Medical Centre. An investigation was conducted on 2155 cases utilising Receiver Operating Characteristic (ROC) and Sensitivity Indices Test analyses to ascertain the most effective cut-off points, specificities, sensitivity, predictive values, likelihood ratios, Youden and accuracy indices, and mortality rates. The research discovered that serial termination points with lower values suggested more robust evidence for a positive actual state, whereas higher values suggested less robust evidence for a negative actual state. A Binary Logistic Regression (BLgR) test was performed to examine correlations, the extent of total variations in the dependent variable, and the accuracy of the prediction for each Na-related mortality prognosticator in relation to overall mortality. The analysis was conducted utilising version 25 of SPSS for Windows. Results: The research revealed that the AUROC for cNa was considerably greater in magnitude compared to its prognosticator that is genealogically related to Na. 129.35 mEq/l and 131.05 mEq/l were the optimal cut-off points, TPRs, TNRs, PPVs, NLRs, YIs, and AIs for the two comparative Na investigated statutes. The BLgR models were developed in order to simulate the relationship between the corrected and measured Na levels of patients and their overall mortality rate. For critically ill patients, the probabilities of overall mortality at the optimal cutoff operating Na levels were 79.59 and 81.62 percent, respectively.

Concurrent reversible splenial lesion syndrome and extrapontine osmotic demyelination syndrome associated with hypernatremia.

Concurrent reversible splenial lesion syndrome and extrapontine osmotic demyelination syndrome associated with hypernatremia.

Safety and efficacy of proactive versus reactive administration of desmopressin in severe symptomatic hyponatremia: a randomized controlled trial

This randomized controlled trial aimed to evaluate the safety and efficacy of proactive versus reactive desmopressin (DDAVP) strategies in treating severe symptomatic hyponatremia. Conducted from June 20, 2022, to February 20, 2023, it involved 49 patients with serum sodium levels below 125 mmol/L. Patients were assigned to either the proactive group, receiving DDAVP immediately upon diagnosis, or the reactive group, receiving DDAVP only if the serum sodium level tended to be overcorrected. The primary outcome was the incidence of overcorrection. The study revealed no significant difference in the overcorrection incidence between the proactive (16.7%) and reactive (28%) groups (p = 0.54). The change in serum sodium levels at 1, 6, 12, and 24 h were not different, however, at 48 h, the proactive group exhibited a higher but still safe change in serum sodium levels compared to the reactive group (10.3 ± 3.6 mmol/L vs. 7.7 ± 3.6 mmol/L, p = 0.013). Other parameters including time to symptom improvement, total intravenous fluid administered, DDAVP dose, urine volume, hospital stay duration, osmotic demyelination syndrome incidence, and 28-day mortality did not significantly differ between the groups. In conclusion, our findings suggest that there was no significant disparity in overcorrection rates between proactive and reactive DDAVP strategies for treating severe symptomatic hyponatremia. However, further large-scale studies are warranted to validate these results.

Retracted: Osmotic Demyelination Syndrome: Clinical, Neuroimaging Characteristics, and Outcomes in a Series of 18 Cases.

[This retracts the article DOI: 10.1155/2021/9944632.].

Study of Clinicoetiological profile of hyponatremia patients admitted in Medical wards

Hyponatraemia is the most common electrolyte disorder in hospitalized patients. Its epidemiology depends on the serum sodium used to define hyponatraemia, which varies from study to study. It can be an early or even first sign of important underlying disease. It can be complicated by two types of neurological disorders cerebral oedema and osmotic demyelination syndrome. It is associated with increased morbidity and mortality rates in hospitalized patients, although it remains unclear whether these associations are mainly due to the underlying disease, direct effects of hyponatraemia, or a combination of both. Aims and Objectives - to study clinical profile of hyponatremia in hospitalized subjects. To study the aetiology of hyponatremia in hospitalized subjects. To assess morbidity and mortality due to hyponatremia. Materials and Methods - 100 patients with hyponatremia were studied. Most common symptoms were Lethargy and tremors, followed by headache, nausea, altered sensorium, convulsion and coma, in order. Hypervolemic hyponatremia is most common followed by euvolemic hyponatremia and hypovolemic hyponatremia. Euvolemic subjects had propensity to develop more severe and symptomatic hyponatremia. Dilutional hyponatremia is the most prevalent underlying pathophysiology of hyponatremia followed by diuretic use, SIADH, GI loss, Hypothyroidism, extra renal/GI loss and Cerebral salt wasting in order. Congestive cardiac failure was the most common cause of hypervolemic hyponatremia, followed by cirrhosis of liver and renal failure. Acute gastroenteritis was most common cause of hypovolemic hyponatremia. SIADH was the most common cause of euvolemic hyponatremia, followed by thiazide diuretics and hypothyroidism, in order.

Assessment of 2% vs 3% Peripheral Hypertonic Sodium Chloride Administration and Its Impact on Safe and Timely Treatment

Abstract Objectives Evaluate if peripheral administration of 3% hypertonic saline (HTS) provides timely treatment with a rate of infusion-related adverse events at or below what is reported in the literature. Methods This was a single-center, retrospective study conducted in a large academic medical center in New York City. Eligible patients were inpatients receiving either 2% or 3% HTS for severe hyponatremia, elevated intracranial pressure, or cerebral edema. The primary outcome was incidence of infusion-related adverse events. Secondary endpoints included achievement of appropriate sodium correction, incidence of over-correction, length of time from ordering to medication administration, and incidence of osmotic demyelination syndrome (ODS). Main Results A total of 199 patients were included in analysis (85 in the 3% HTS group and 114 in the 2% HTS group). No difference was found between groups for rate of infusion related adverse events or incidence of sodium overcorrection groups (0 vs 1 [0.9%]; p = 0.39). Significantly more patients in the 3% HTS group received intermittent administration (p < 0.001), whereas more patients in the 2% HTS group received a continuous infusion (p < 0.001). There were no reports of ODS in either group. No difference in length of time to administration was found between groups. Conclusion Our study, one of the largest to evaluate peripheral administration of 3% HTS, found that it is not associated with an increase in infusion related adverse events or sodium overcorrection versus 2% HTS. Peripheral administration should be recommended to provide timely treatment for patients requiring HTS.

The Response of Osmotic Demyelination Syndrome to Plasmapheresis in a Patient Presenting with Catatonia after Correction of Hyponatraemia in Hyperemesis Gravidarum.

Osmotic demyelination syndrome (ODS) is a rare but potentially devastating neurological complication, such as catatonia, resulting from the correction of hyponatraemia.Pregnancies complicated by hyperemesis gravidarum tend to exhibit hyponatraemia and hypokalaemia, which serve as contributing risk factors for ODS.Plasmapheresis is considered as an option in the treatment of ODS for the removal of inflammatory substances.

Hand knob sign in osmotic demyelinating syndrome

BackgroundOsmotic demyelinating syndrome, commonly recognized as a consequence of the rapid correction of hyponatremia, has been known to cause motor, neuropsychiatric, or extrapyramidal symptoms. We reported a patient with an unusual presentation involving bilateral hand weakness, and pseudobulbar affect. The imaging was compatible with osmotic demyelinating syndrome with bilateral hand knob lesions, despite no history of overcorrection of hyponatremia.Case presentationA 44-year-old female presented with three weeks of emotional lability, spastic dysarthria, and bilateral hand weakness following ankle surgery and a mild head injury. Physical examination revealed weakness in the intrinsic hand muscles, leading to a claw-like deformity of the hands, although sensation remained unimpaired. Magnetic resonance imaging (MRI) of the brain revealed several hyperintensities on fluid-attenuated inversion recovery imaging involving various areas, including the hand knob area of the bilateral precentral gyri, caudate, lentiform nuclei, and pons, suggestive of osmotic demyelinating syndrome. Clinical improvement was observed following a trial of intravenous pulse methylprednisolone and plasmapheresis.ConclusionsBilateral hand weakness is an unusual manifestation of osmotic demyelinating syndrome. The precentral gyrus, specifically in the hand knob area, is the vulnerable region that can result from osmotic demyelinating syndrome.

Psychosis Due to Osmotic (Pontine) Myelinolysis in Non-Hodgkin’s Lymphoma: Case Report

Introduction: central pontine myelinolysis (CPM) is rare neurological condition. The severe symptoms of neurologic and psychiatric disorders accompanying this condition are not sufficiently disclosed in the literature. Most often CPM develops on infusion therapy and forced correction of hyponatremia. The complexity of diagnosis and the lack of certain algorithms for the management of this category of patients cause a high frequency of disability, persistent neurological and psychiatric symptoms, and lethal outcomes.The aim was to present and analyze clinical picture of psychosis in CPM on the example of non-Hodgkin’s lymphoma case report. Patient and method: clinical analysis of disorders in 14-years old patient with diagnosis of non-Hodgkin’s lymphoma.Results: clinical polymorphism of psychotic features, catatonic disorders, neurological symptoms at the end stage and development of psychosis associated with CPM during cytotoxic treatment. A year and a half follow-up of the first generation antipsychotics administration is presented.Conclusion: CPM may occur on cytotoxic infusion therapy in patients with non-Hodgkin’s lymphoma and be accompanied by severe psychotic disorders. Thus, practitioners should be aware of the risks of this condition, its diagnostic and therapeutic options when working with these patients.

Osmotic demyelination as a complication of hyponatremia correction: a systematic review

RESUMO Antecedentes: A correção rápida da hiponatremia, principalmente quando grave e crônica, pode resultar em desmielinização osmótica. A última diretriz para diagnóstico e tratamento da hiponatremia (2014) recomenda um limite de correção de 10 mEq/L/dia. Nosso objetivo foi sumarizar os casos publicados de desmielinização osmótica para avaliar a adequação dessa recomendação. Método: Revisão sistemática de relatos de caso de desmielinização osmótica. Incluímos casos confirmados por imagem ou anatomia patológica, em maiores de 18 anos, publicados entre 1997 e 2019, nas línguas inglesa ou portuguesa. Resultados: Avaliamos 96 casos de desmielinização osmótica, sendo 58,3% do sexo feminino e com média de idade de 48,2 ± 12,9 anos. A mediana de sódio sérico admissional foi 105 mEq/L e > 90% dos pacientes apresentavam hiponatremia grave (<120 mEq/L). Foram comuns os relatos de distúrbios do trato gastrointestinal (38,5%), etilismo (31,3%) e uso de diuréticos (27%). A correção da hiponatremia foi feita principalmente com solução salina isotônica (46,9%) ou hipertônica (33,7%). Correção de hipocalemia associada ocorreu em 18,8%. Em 66,6% dos casos houve correção da natremia acima de 10 mEq/L no primeiro dia de internamento; a velocidade não foi relatada em 22,9% e em apenas 10,4% foi menor que 10 mEq/L/dia. Conclusão: O desenvolvimento da desmielinização osmótica foi predominante em mulheres, abaixo de 50 anos, com hiponatremia grave e correção rápida. Em 10,4% dos casos, houve desmielinização mesmo com correção <10 mEq/L/dia. Esses dados reforçam a necessidade de alvos conservadores para pacientes de alto risco, como 4–6 mEq/L/dia, não ultrapassando o limite de 8 mEq/L/dia.

[Consensus recommendations on the diagnosis and treatment of hyponatremia from the Austrian Society for Nephrology 2024].

Hyponatremia is adisorder of water homeostasis. Water balance is maintained by the collaboration of renal function and cerebral structures, which regulate thirst mechanisms and secretion of the antidiuretic hormone. Measurement of serum-osmolality, urine osmolality and urine-sodium concentration help to diagnose the different reasons for hyponatremia. Hyponatremia induces cerebral edema and might lead to severe neurological symptoms, which need acute therapy. Also, mild forms of hyponatremia should be treated causally, or at least symptomatically. An inadequate fast increase of the serum sodium level should be avoided, because it raises the risk of cerebral osmotic demyelination. Basic pathophysiological knowledge is necessary to identify the different reasons for hyponatremia which need different therapeutic procedures.

Osmotic demyelinating syndrome and its manifestations

Osmotic demyelination syndrome (ODS) is a rare and severe dysmetabolic lesion of the central nervous system which is difficult to diagnose. Its prevalence in the general population reaches 0.5 %, and in intensive care nits — 2.5 %. Within the framework of ODS, central pontine myelinolysis with demyelination of the pons and extrapontine myelinolysis with foci of demyelination in the cerebellum and cerebral hemispheres are distinguished. Clinical cases of ODS that developed against the background of dehydration are presented

A Case Report in the Management of Dysphagia in Osmotic Demyelination Syndrome Using Mann Assessment of Swallowing Ability (MASA)

A Case Report in the Management of Dysphagia in Osmotic Demyelination Syndrome Using Mann Assessment of Swallowing Ability (MASA)

Osmotic Demyelination Syndrome in a Patient with Diabetic Ketoacidosis Despite No Rapid Sodium Correction.

Osmotic demyelination syndrome (ODS) occurs in patients with diabetes and hyponatremia. We herein report a case of ODS with chorea detected on serial magnetic resonance imaging (MRI), despite no prompt hyponatremia correction. A 74-year-old man with cirrhosis and uncontrolled type 2 diabetes developed an altered mental status and chorea during treatment for diabetic ketoacidosis (DKA). Despite no rapid sodium correction and normal initial brain MRI findings, serial MRI revealed ODS-related abnormalities. Clinicians should consider ODS in patients with DKA and a hyperosmolar hyperglycemic state displaying unconsciousness and neurological manifestations, including chorea, even without substantial changes in serum sodium levels. An MRI re-examination can help capture missing ODS complications.

Central Pontine and Extrapontine Myelinolysis with Severe Hypernatremia.

Central Pontine and Extrapontine Myelinolysis with Severe Hypernatremia.

Treatment of Severe Trismus during Locked-In Syndrome Secondary to Central Pontine Myelinolysis Using Onabotulinum Toxin-A: Case Report

Trismus in adults has a wide range of known causes, though few cases have ever been reported secondary to central pontine myelinolysis (CPM). This report describes a case of severe trismus without clear etiology successfully treated with onabotulinum toxin-A following development of CPM.

Central Pontine Myelinosis- A Case Report

Central pontine myelinosis(CPM) is a rare neurologic condition most frequently caused by the rapid correction of hyponatremia due to demyelination which is non inflammatory. Here we report a case of 55 years old male presented with sudden onset of abnormal movements of the whole body with reduced alertness and difficulty in swallowing. On evaluation MRI brain shows lesions in the pons which is suggestive of central pontine myelinosis. It is characterized by damage to regions of the brain, most commonly pontine white matter infarcts, after correction of metabolic disturbances such as hyponatremia. The condition is rarely seen due to under-diagnosis.

Central Pontine Myelinolysis with Extrapontine Involvement in a Case of Chronic Alcoholism without Dysnatremia

Central Pontine Myelinolysis with Extrapontine Involvement in a Case of Chronic Alcoholism without Dysnatremia

Hyperglycaemia and central pontine myelinolysis: Not to ignore

Hyperglycaemia and central pontine myelinolysis: Not to ignore

Thalamic Neuron Resilience during Osmotic Demyelination Syndrome (ODS) Is Revealed by Primary Cilium Outgrowth and ADP-ribosylation factor-like protein 13B Labeling in Axon Initial Segment.

A murine osmotic demyelinating syndrome (ODS) model was developed through chronic hyponatremia, induced by desmopressin subcutaneous implants, followed by precipitous sodium restoration. The thalamic ventral posterolateral (VPL) and ventral posteromedial (VPM) relay nuclei were the most demyelinated regions where neuroglial damage could be evidenced without immune response. This report showed that following chronic hyponatremia, 12 h and 48 h time lapses after rebalancing osmolarity, amid the ODS-degraded outskirts, some resilient neuronal cell bodies built up primary cilium and axon hillock regions that extended into axon initial segments (AIS) where ADP-ribosylation factor-like protein 13B (ARL13B)-immunolabeled rod-like shape content was revealed. These AIS-labeled shaft lengths appeared proportional with the distance of neuronal cell bodies away from the ODS damaged epicenter and time lapses after correction of hyponatremia. Fine structure examination verified these neuron abundant transcriptions and translation regions marked by the ARL13B labeling associated with cell neurotubules and their complex cytoskeletal macromolecular architecture. This necessitated energetic transport to organize and restore those AIS away from the damaged ODS core demyelinated zone in the murine model. These labeled structures could substantiate how thalamic neuron resilience occurred as possible steps of a healing course out of ODS.