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Osmotic myelinolysis in a normonatremic patient
Münire Kilinç1, Ulkü Sibel Benli, Ufuk Can
1Başkent University Faculty of Medicine, Neurology Department Fevzi Cakmak Caddesi, Ankara, Turkey. munirekilinc@superonline.com
Abstract:
Osmotic demyelination syndrome is usually associated with hyponatremia or rapid correction of this condition. The prognosis is usually fatal. We treated a 34-year-old chronic renal failure patient who did not have hyponatremia but developed severe pontine myelinolysis demonstrated with MRI. Serial MRI revealed gradual reduction of the lesions over 2 months. This case demonstrates that osmotic demyelination syndrome is not always associated with hyponatremia, and that, although the prognosis is usually poor, some patients recover.
Insights
Osmotic demyelination syndrome can occur without hyponatremia. This case report shows pontine myelinolysis lesions improving over two months, suggesting recovery is possible even with a poor prognosis.
Area of Science:
- Neurology
- Radiology
- Nephrology
Background:
- Osmotic demyelination syndrome (ODS) is a severe neurological condition.
- It is typically linked to hyponatremia or its rapid correction.
- ODS often carries a poor or fatal prognosis.
Observation:
- A 34-year-old patient with chronic renal failure presented with severe pontine myelinolysis.
- The patient did not have hyponatremia.
- Magnetic resonance imaging (MRI) confirmed the pontine lesions.
Findings:
- Serial MRI scans over two months showed a gradual reduction in the size of the demyelination lesions.
- This case challenges the typical association of ODS solely with hyponatremia.
- The findings suggest that ODS can develop in the absence of hyponatremia.
Implications:
- ODS may occur in patients without hyponatremia, broadening its diagnostic considerations.
- Despite a generally poor prognosis, recovery from ODS is possible.
- This case highlights the importance of MRI in diagnosing ODS and monitoring treatment response.