Related Experiment Video
Updated: Apr 20, 2026

Osmotic Minipump Implantation for Increasing Glucose Concentration in Mouse Cerebrospinal Fluid
Published on: April 7, 2023
Osmotic demyelination syndrome as the initial manifestation of a hyperosmolar hyperglycemic state
Karla Victoria Rodríguez-Velver1, Analy J Soto-Garcia2, María Azucena Zapata-Rivera1
1Endocrinology Division, University Hospital "Dr. José E. González" and Medical School of the Autonomous University of Nuevo León, Madero and Gonzalitos s/n, 64460 Monterrey, NL, Mexico.
Abstract:
Osmotic demyelination syndrome (ODS) is a life-threatening demyelinating syndrome. The association of ODS with hyperosmolar hyperglycemic state (HHS) has been seldom reported. The aim of this study was to present and discuss previous cases and the pathophysiological mechanisms involved in ODS secondary to HHS. A 47-year-old man arrived to the emergency room due to generalized tonic-clonic seizures and altered mental status. The patient was lethargic and had a Glasgow coma scale of 11/15, muscle strength was 4/5 in both lower extremities, and deep tendon reflexes were diminished. Glucose was 838 mg/dL; serum sodium and venous blood gas analyses were normal. Urinary and plasma ketones were negative. Brain magnetic resonance revealed increased signal intensity on T2-weighted FLAIR images with restricted diffusion on the medulla and central pons. Supportive therapy was started and during the next 3 weeks the patient progressively regained consciousness and muscle strength and was able to feed himself. At 6-month follow-up, the patient was asymptomatic and MRI showed no residual damage. In conclusion, the association of ODS with HHS is extremely rare. The exact mechanism by which HHS produces ODS still needs to be elucidated, but we favor a rapid hypertonic insult as the most plausible mechanism.
Related Concept Videos
Hyperosmolar Hyperglycemic State
Type I Diabetes III: Clinical Manifestations
Diabetic Ketoacidosis l: Introduction
Diabetic Neuropathy
Hyperglycemia
Type II Diabetes Mellitus III: Clinical Manifestations and Diagnosis

