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Osmotic demyelination syndrome

T Ravindran, Paneerselvam, Radha, T Allwyn Yabesh
Osmotic demyelination syndrome is an acute shift in serum osmolality causing demyelination, which may be due to rapid correction of hyponatremia, hyperglycaemia, hypokalemia and ketoacidosis. We present a case of 55yr old female and a known diabetic presented with the choreic movements involving left upper and lower limb for 2 days without any weakness.Her blood sugar was 428mg/dl at the time of admission with wide fluctuations.Her CT Brain showed hyperdensity in the right basal ganglia and the MRI brain showed hyperintense lesion in T2 weighted images showing features suggestive of osmotic demyelination...
April 2016: Journal of the Association of Physicians of India
Nicolae Sarbu, Robert Y Shih, Robert V Jones, Iren Horkayne-Szakaly, Laura Oleaga, James G Smirniotopoulos
White matter diseases include a wide spectrum of disorders that have in common impairment of normal myelination, either by secondary destruction of previously myelinated structures (demyelinating processes) or by primary abnormalities of myelin formation (dysmyelinating processes). The pathogenesis of many white matter diseases remains poorly understood. Demyelinating disorders are the object of this review and will be further divided into autoimmune, infectious, vascular, and toxic-metabolic processes. Autoimmune processes include multiple sclerosis and related diseases: tumefactive demyelinating lesions, Balo concentric sclerosis, Marburg and Schilder variants, neuromyelitis optica (Devic disease), acute disseminated encephalomyelitis, and acute hemorrhagic leukoencephalopathy (Hurst disease)...
September 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Yaasir Mamoojee, Rasha Mukhtar
Currently available guidelines in the acute management of severely symptomatic hypotonic hyponatremia vary in their approach to the use of hypertonic saline. In the acute setting, deciding on when to implement available treatment algorithm using hypertonic saline may be difficult, given that the duration of hyponatremia and potential alternative diagnoses presenting with similar symptoms may be hard to establish promptly. We present the case of a young female with symptomatic profound hyponatremia who subsequently developed osmotic demyelination syndrome due to rapid overcorrection of serum sodium concentration...
October 2016: Hospital Practice (Minneapolis)
Yin-Chou Hsu, Yu-Chang Lee, Chih-Wei Hsu
No abstract text is available yet for this article.
August 16, 2016: American Journal of Emergency Medicine
Ramy Magdy Hanna, Wan-Ting Yang, Eduardo A Lopez, Joseph Nabil Riad, James Wilson
BACKGROUND: Improper correction of hyponatremia can cause severe complications, including osmotic demyelination syndrome (ODS). The Adrogué-Madias equation (AM), the Barsoum-Levine (BL) equation, the Electrolyte Free Water Clearance (EFWC) equation and the Nguyen-Kurtz (NK) equation are four derived equations based on the empirically derived Edelman equation for predicting sodium at a later time (Na2) from a known starting sodium (Na1), fluid/electrolyte composition and input and output volumes...
August 2016: Clinical Kidney Journal
Ryoji Aoki, Tetsuji Morimoto, Yuno Takahashi, Hiroshi Saito, Tatsuo Fuchigami, Shori Takahashi
Extrapontine myelinolysis (EPM) is an uncommon disorder in children, with few pediatric cases reported to date. We report the first case of an infant with EPM without central pontine myelinolysis (CPM) presenting with severe hypernatremia. On admission, the infant had impaired consciousness, mild dehydration, and severe hypernatremia (190 mmol/L). The following day, the patient developed abnormal involuntary movements. Brain magnetic resonance imaging (MRI) confirmed EPM without CPM. He recovered without sequelae, and clinical examinations were within normal limits approximately 6 months after discharge...
September 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
James E Siegler, Amber R Wang, Joshua D Vanderwerf
In this report, we present the case of a 43-year-old woman with AIDS, disseminated aspergillosis, and malnutrition who developed osmotic demyelination syndrome. AIDS-related osmotic demyelination has only been documented in a handful of cases to date, and it appears independent of the classic mechanism of rapid correction of hyponatremia. In this manuscript, we review the six prior cases of osmotic demyelination in AIDS patients and compare their circumstances to that of our own patient. It appears that complications of malnutrition, possibly related to depletion of organic osmolytes in the central nervous system, may place AIDS patients at greater risk of osmotic demyelination...
July 12, 2016: Journal of Neurovirology
Kaushik Chatterjee, Austin B Fernandes, Sunil Goyal, Sunitha Shanker
Osmotic Demyelination Syndrome includes Central Pontine Myelinolysis and Extrapontine Myelinolysis. This condition has been described in cases of chronic Alcohol Dependence Syndrome and in rapid correction of hyponatremia. Though we frequently see patients with Alcohol Dependence Syndrome presenting with complicated withdrawal, Central Pontine Myelinolysis remains largely undetected and under-reported in literature. We present here a case of protracted Delirium Tremens where MRI brain revealed Central Pontine Myelinolysis...
July 2015: Industrial Psychiatry Journal
S G Ball, Zohaib Iqbal
Hyponatraemia is the most common electrolyte abnormality encountered by physicians in the hospital setting. It is associated with increased mortality and length of hospital stay. However, the basis of the relationship of hyponatraemia with clinical outcome is not clear. Doubt remains as to whether the relationship is causal. It may reflect the association of two independent variables both of which are linked with disease severity. Serum sodium concentration is regulated through integrated neuro-humeral mechanisms that overlap with those regulating circulating volume...
March 2016: Best Practice & Research. Clinical Endocrinology & Metabolism
Theodosios D Filippatos, George Liamis, Moses S Elisaf
Hyponatremia (serum sodium <135 mEq/L) is a common electrolyte disorder in community or hospitalized patients. Serum sodium levels should be corrected at a proper rate in patients with hyponatremia, since overcorrection of serum sodium levels is related to devastating neurologic consequences, such as the osmotic demyelination syndrome (ODS). However, a number of pitfalls, which could lead to undercorrection or overcorrection of hyponatremia, are common during the treatment of hyponatremic patients. Hereby, we describe ten common pitfalls that are observed during the correction of serum sodium concentration in hyponatremic patients...
June 2016: Postgraduate Medicine
Kunakorn Atchaneeyasakul, Anita Tipirneni, Salomon Gloria, Andrew C Berry, Kush Shah, Dileep R Yavagal
No abstract text is available yet for this article.
April 18, 2016: Internal and Emergency Medicine
Raj Kanwar Yadav, Chandan J Das, Soumita Bagchi, Sanjay Agarwal
Osmotic demyelination syndrome leading to central pontine/extra-pontine myelinolysis (CPM/EPM) occurs mainly in patients with history of alcohol abuse, malnourishment, following liver transplantation and less commonly, in association with other systemic diseases. Asymptomatic CPM/EPM is rare. Patients with end-stage renal disease (ESRD) who develop CPM/EPM are usually symptomatic with florid neurologic manifestations. Herein, we present a patient with ESRD on maintenance hemodialysis who was incidentally detected to have pontine and extra-pontine lesions suggestive of myelinolysis without any neurologic signs or symptoms...
March 2016: Saudi Journal of Kidney Diseases and Transplantation
Susan Canaday, John Rompala, John Rowles, Josh Fisher, David Holt
Serum sodium concentration affects every cell in the body with respect to cellular tonicity. Hyponatremia is the most frequent electrolyte abnormality encountered, occurring at clinical admission in 22% of elderly patients. Any rapid correction of chronic severe hyponatremia can result in rapid cellular shrinking due to loss of intracellular free water. This is commonly associated with paralysis and severe brain damage due to osmotic demyelination syndrome (ODS). ODS occurs because the body has the ability to compensate for cellular fluid shifts due to chronic hyponatremia (by a decrease in brain concentration of several ions, amino acids, and organic osmolytes)...
December 2015: Journal of Extra-corporeal Technology
Ivan Adamec, Filip Keršić, Luka Crnošija, Mario Habek
No abstract text is available yet for this article.
June 2016: Neurological Sciences
Machiko Tajitsu, Tsutomu Yamada, Xia Cao, Ayako Fukui, Junko Nagai, Yuko Yambe, Takashi Murase, Hisashi Okada
ODS associated with hyperglycemia is rare, with few reports.Immune responses have been recently reported as a mechanism of ODS onset. In the present case, an autoimmune predisposition may have contributed to ODS pathogenesis.
January 2016: Journal of Diabetes Investigation
Suresh Thirunavukarasu, Asthik Biswas, Farha Furruqh, Anandavelou Gnanavelan
No abstract text is available yet for this article.
2015: BMJ Case Reports
Pierce Geoghegan, Andrew M Harrison, Charat Thongprayoon, Rahul Kashyap, Adil Ahmed, Yue Dong, Alejandro A Rabinstein, Kianoush B Kashani, Ognjen Gajic
OBJECTIVES: To assess the epidemiology of nonoptimal hyponatremia correction and to identify associated morbidity and in-hospital mortality. PATIENTS AND METHODS: An electronic medical record search identified all patients admitted with profound hyponatremia (sodium <120 mmol/L) from January 1, 2008, through December 31, 2012. Patients were classified as having optimally or nonoptimally corrected hyponatremia at 24 hours after admission. Optimal correction was defined as sodium correction in 24 hours of 6 through 10 mmol/L...
October 2015: Mayo Clinic Proceedings
Ploutarchos Tzoulis, Julian A Waung, Emmanouil Bagkeris, Helen Carr, Bernard Khoo, Mark Cohen, Pierre Marc Bouloux
OBJECTIVE: European guidelines do not recommend tolvaptan for treatment of syndrome of inappropriate antidiuretic hormone secretion (SIADH), principally owing to concerns about risk of overly rapid correction of hyponatraemia. This study evaluated the real-life effectiveness and safety of tolvaptan. DESIGN: Consecutive case series. PATIENTS: Inpatients treated with tolvaptan for SIADH in 2 UK hospitals over a 3-year period. MEASUREMENTS: The primary outcome measures were serum sodium (sNa) correction at 24 and 48 h after tolvaptan therapy...
April 2016: Clinical Endocrinology
Min Jee Han, Do Hyoung Kim, Young Hwa Kim, In Mo Yang, Joon Hyung Park, Moon Ki Hong
Osmotic demyelination syndrome is a demyelinating disorder associated with rapid correction of hyponatremia. But, it rarely occurs in acute hypernatremia, and it leads to permanent neurologic symptoms and is associated with high mortality. A 44-year-old woman treated with alternative medicine was admitted with a history of drowsy mental status. Severe hypernatremia (197mEq/L) with hyperosmolality (415mOsm/kgH2O) was evident initially and magnetic resonance imaging revealed a high signal intensity lesion in the pons, consistent with central pontine myelinolysis...
June 2015: Electrolyte & Blood Pressure: E & BP
Corinna Giuliani, Alessandro Peri
Hyponatremia is a very common electrolyte disorder, especially in the elderly, and is associated with significant morbidity, mortality and disability. In particular, the consequences of acute hyponatremia on the brain may be severe, including permanent disability and death. Also chronic hyponatremia can affect the health status, causing attention deficit, gait instability, increased risk of falls and fractures, and osteoporosis. Furthermore, an overly rapid correction of hyponatremia can be associated with irreversible brain damage, which may be the result of the osmotic demyelination syndrome...
2014: Journal of Clinical Medicine
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