An Interesting Case Report of Complete Neurological Recovery in Osmotic Demyelination Syndrome

Dr. Jyoti Goyal, Dr. Vipul Mishra, Dr. Abhishek Chaubey

Abstract: We report a case of osmotic demyelination syndrome happened because of rapid correction of severe chronic hyponatremia occurred after use of 0.9 % normal saline. He had all the risk factors for development of osmotic demyelination syndrome like chronic alcoholism, malnourishment, liver disease, very low baseline sodium level and hypokalemia. Sodium relowering therapy with help of 5 % dextrose and desmopressin was immediately started to prevent development of ODS. Despite of this patient developed classical symptoms of ODS on 5th day. MRI brain showed characteristic T2 weighted hyper intensities in pons as well as in extra pontine regions confirmed the diagnosis of ODS. Aggressive supportive therapy along with systemic steroids was started to reverse this. As opposed to dismal prognosis mentioned in the literature for established ODS, our patient had full neurological recovery in four months period. This report emphasizes on importance of timely recognition and anticipation of this illness, immediate use of dextrose and desmopressin to relower sodium levels and aggressive supportive therapy for prevention and treatment of ODS.

Keywords: ODS, Sodium, Potassium, Hyponatremia, Hypokalemia, MRI Brain, Dextrose and Desmopressin