Related Experiment Video
Updated: Jan 13, 2026
High-throughput Flow Cytometry Cell-based Assay to Detect Antibodies to N-Methyl-D-aspartate Receptor or Dopamine-2 Receptor in Human Serum
Published on: November 23, 2013
Non-hyponatremia-associated osmotic demyelination syndrome: an analysis of published cases
Svenja Ravioli1, Florian Fussi1, Christoph Schwarz2
1Department of Emergency Medicine, Kepler University Hospital Linz, Johannes Kepler University Linz, Austria.
Background:
Osmotic demyelination syndrome (ODS), formerly known as central pontine myelinolysis, is classically associated with rapid correction of hyponatremia. However, ODS has also been reported in normo- or hypernatremic patients, often linked to other metabolic or systemic risk factors. Despite numerous single-case reports, systematic data on non-hyponatremia ODS remain scarce. This study aimed to summarize clinical characteristics, possible causes, and outcomes of ODS in patients without hyponatremia.
Methods:
A systematic PubMed search was conducted for case reports on ODS or central pontine myelinolysis published between January 1990 and December 2024. Cases were included if serum sodium was ≥ 135 mmol/L. Extracted data comprised demographics, laboratory parameters, risk factors, causes of ODS, imaging findings, treatment and outcome. Statistical analyses were descriptive and performed using JASP 0.95.0.
Results:
A total of 169 cases from 161 publications were identified. The mean age was 42 years, and 44% were female. MRI confirmed ODS in 96% of cases. Median sodium concentration was 140 mmol/L, with 42% showing hypernatremia. Hypokalemia was present in 24% and diabetes mellitus in 28%. Common risk factors for ODS included alcohol abuse (26%), liver disease (18%) and malnutrition (11%). Treatment approaches were heterogeneous 28 patients received glucocorticoids, but immunoglobulins or plasmapheresis were rarely used. Full recovery occurred in 47%, while mortality was 9.5%.
Conclusions:
ODS can occur in the absence of hyponatremia, particularly in patients with electrolyte disturbances or systemic risk factors. The condition remains underrecognized and heterogeneously managed. Awareness of non-hyponatremia ODS and standardized treatment protocols are needed to improve patient outcomes.
