Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 18 , ISSUE 9 ( September, 2014 ) > List of Articles


Osmotic demyelination syndrome in a normonatremic patient of chronic kidney disease

Atul Abhishek Jha, Vineet Behera, Anantharam Jairam, Krishna Venkatesh Baliga

Keywords : Central pontine myelinosis, chronic kidney disease, hyponatremia, normonatremia, osmotic demyelination syndrome

Citation Information : Jha AA, Behera V, Jairam A, Baliga KV. Osmotic demyelination syndrome in a normonatremic patient of chronic kidney disease. Indian J Crit Care Med 2014; 18 (9):609-611.

DOI: 10.4103/0972-5229.140153

License: CC BY-ND 3.0

Published Online: 01-10-2007

Copyright Statement:  Copyright © 2014; The Author(s).


Osmotic Demyelination Syndrome (ODS) is associated with rapid correction of hyponatremia or fluid shifts, and is characterized by neurological involvement related to pons, brainstem or other areas of the brain. All possible measures should be taken to prevent this serious disorder. Diagnosing this condition early is very important and requires a high index of suspicion. The treatment is purely supportive and most patients may show dramatic recovery. ODS occurring in normonatremic and hypernatremic patients is very rare. We report a case of an 18-year-old boy of end-stage renal disease who presented with an episode of acute gastroenteritis. He was managed with aggressive intravenous fluids, hemodialysis and other supportive therapy. But, he developed altered sensorium and seizures that progressed to features of spastic quadriparesis and lower cranial nerve palsy. Neuroimaging showed hyperintensities in pons and midbrain suggestive of ODS. The patient had normal sodium levels at all times and had no evidence of hyponatremia. The patient was managed with hemodialysis, physiotherapy and other conservative measures and had a gradual clinical and radiological recovery.

PDF Share
  1. Moritz ML, Ayus JC. The pathophysiology and treatment of hyponatraemic encephalopathy: An update. Nephrol Dial Transplant 2003;18:2486-91.
  2. Adams RD, Victor M, Mancall El. Central pontine myelinolysis: A hitherto undescribed disease occurring in alcoholic and malnourished patients. Arch. Neurol. Pschiatry 1959;81:154-72.
  3. Mascalchi M, Cincotta M, Piazzini M. Case report: MRI demonstration of pontine and thalamic myelinolysis in a normonatremic alcoholic. Clin Radiol 1993;47:137-8.
  4. Lohr JW. Osmotic demyelination syndrome following correction of hyponatremia: Association with hypokalemia. Am J Med 1994;96:408-13.
  5. Bernsen HJ, Prick MJ. Improvement of central pontine myelinolysis as demonstrated by repeated magnetic resonance imaging in a patient without evidence of hyponatraemia. Acta Neurol Belg 1999;99:189-93.
  6. Lauren R, Illowsky BK. Myelinolysis after correction of hyponatraemia. Ann Intern Med 1997;126:57-62.
  7. Norenberg MD, Leslie KO, Robertson AS. Association between rise in serum sodium and central pontine myelinolysis. Ann Neurol 1982;11:128-35.
  8. Brunner JE, Redmond JM, Haggar AM, Kruger DF, Elias SB. Central pontine myelinolysis and pontine lesions after rapid correction of hyponatremia: A prospective magnetic resonance imaging study. Ann Neurol 1990;27:61-6.
  9. Ruzek KA, Campeau NG, Miller GM. Early diagnosis of central pontine myelinolysis with diffusion-weighted imaging. AJNR Am J Neuroradiol 2004;25:210-3.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.