Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: May 3 2019

Osmotic Demyelination Syndrome (ODS)

  • Snapshot
    • A 66-year-old man presents to the emergency department after being found down in a park. He is accompanied by a person who witnessed the fall, who said he had seizure-like activity prior to falling on the floor. The patient is non-participatory on exam but is able to breath on his own. Laboratory studies is significant for a serum sodium of 117 mEq/L. Over the course of 6 hours, his serum sodium was corrected to 135 mEq/L. Subsequently, in the next few days he develops quadrapresis with preservation of eye blinking.
  • Introduction
    • Definition
      • neurological sequelae from rapid fluctuations in brain osmolality
  • Epidemiology
    • Risk factors
      • chronic hypernatremia
      • rapid sodium correction (> 8-10 mEq/day)
  • Pathogenesis
    • Normally, the brain has adaptive mechanisms to prevent swelling in hypotonic states
      • recall that hypotonicity in the serum favors movement of water into cells
    • As the body increases in sodium, it pulls the water out of neurons, dehydrating them, and causing demyelination
      • also causes astrocytic cell death
  • Presentation
    • Symptoms/physical exam
      • can lead to a range of symptoms
        • asymptomatic
        • seizures
        • loss of conciousness
        • dysarthria and dysphagia
        • locked-in syndrome
          • muscle paralysis with sparing of eye blinking
  • Imaging
    • MRI brain
      • indication
        • patients with nonspecific neurological findings after rapid sodium correction
      • findings
        • noninflammatory myelinolysis
  • Differential
    • Wernicke encephalopathy
      • differentiating factor
        • gait ataxia
        • oculomotor dysfunction
        • encephalopathy
  • Treatment
    • Preventative
      • slow sodium correction
        • indication
          • slowly correct sodium 6-8 mEq/L per day in patients with chronic hyponatremia
            • there is no effective treatment for ODS
  • Complications
    • Locked-in syndrome
    • Death
1 of 0
1 of 1
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options