R DAVID1, S DUNKERTON1, J SPIES1, S J CHADBAN1,2, T YING1,2
1Royal Prince Alfred Hospital, Sydney, Australia, 2Kidney Node, Charles Perkin Centre, The University of Sydney, Sydney, Australia
Background: Osmotic demyelination syndrome (ODS) is a demyelinating disease typically seen in the central pons, often associated with a rapid correction of hyponatraemia. It presents with a varied clinical spectrum ranging from asymptomatic patients to dysarthria, dysphagia, oculomotor dysfunction, variable degrees of quadriparesis and locked-in syndrome.
Case Report: This case describes iatrogenic central pontine and extrapontine demyelination, which occurred nine days after rapid correction of hyponatraemia, in a 45-year-old man with a history of chronic alcohol misuse and malnutrition. Despite significantly abnormal clinical and radiological findings, with marked ataxia and dysphagia, we report how this patient improved dramatically with rehabilitation therapy. Indeed, he was discharged from hospital with a higher functional level than his pre-morbid status.
Conclusions: ODS is well recognised in the literature, and with improved protocols for the treatment of hyponatraemia the pathology is now unusual. It is variable in its manifestations, thus without neurology involvement and MRI the diagnosis can be protracted or missed. The description of this case functions as a reminder of the seriousness of ODS as an entity, highlighting the importance of prevention, and that in established cases favourable outcomes can be achieved with rehabilitation therapy.
Advanced Trainee in Nephrology