Osmotic demyelination syndrome: Difference between revisions

Revision as of 12:45, 31 October 2017

Background

Formerly called "central pontine myelinolysis"
A neurologic condition caused by rapid correction of hyponatremia, with starting serum sodium normally 120 meq/L or less
Caused by rapid correction of hyponatremia (>12 mEq/L/24 h), as water moves from cells to extracellular fluid, yielding intracellular dehydration.
Symptoms are often irreversible or only partially reversible

Risk Factors

Chronic heart failure
Alcoholism
Cirrhosis
Hypokalemia
Malnutrition
Treatment with vasopressin antagonists (e.g. tolvaptan)

Clinical Features

Symptoms can be present 2-6 days after rapid correction of serum sodium

Dysarthria
Dysphagia
Lethargy
Behavioral disturbances/ confusion
Paraparesis or quadriparesis
Seizures
"Locked in" syndrome
Coma and death

Differential Diagnosis

Evaluation

MRI can be used to visualize the pontine lesion, with a characteristic "batwing" lesion of the pons appearing in typical cases

Management

In patients with chronic severe hyponatremia (Na <120mEq), the correction rate of sodium should not exceed 6 mEq/24 hours for patients with other ODS risk factors, or 12 mEq/24 hours for those without other risk factors (1). Hypertonic (3%) saline should be given at a low infusion rate, 0.5 to 1 mL/kg/h, with frequent serum sodium checks to ensure that the correction rate does not exceed the above limits.

Disposition

Admit

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-Osmotic demyelination syndrome (ODS; also formerly called central pontine myelinolysis or CPM) is a neurologic condition caused by rapid correction of hyponatremia, and is characterized by dysarthria, dysphagia, lethargy, paraparesis or quadriparesis, seizures, coma, and death.(2)  Osmotic demyelination syndrome was first described in a 1959 paper by Adams, Victor, and Mancall, who described rapidly evolving quadriplegia and pseudobulbar palsy in 3 alcoholic men.
+*Formerly called "central pontine myelinolysis"
+*A neurologic condition caused by rapid correction of hyponatremia, with starting serum sodium normally 120 meq/L or less
+*Caused by rapid correction of hyponatremia (>12 mEq/L/24 h), as water moves from cells to extracellular fluid, yielding intracellular dehydration.
+*Symptoms are often irreversible or only partially reversible
 ===Risk Factors===
-Osmotic demyelination syndrome is caused by rapid correction of hyponatremia (>12 mEq/L/24 h) as water moves from cells to extracellular fluid, yielding intracellular dehydration.  Starting serum sodium concentration is almost always 120 meq/L or less.  Risk factors for osmotic demyelination syndrome include: chronic heart failure, alcoholism, cirrhosis, hypokalemia, malnutrition, and treatment with vasopressin antagonists such as tolvaptan.(1)
+*Chronic heart failure
+*Alcoholism
+*Cirrhosis
+*Hypokalemia
+*Malnutrition
+*Treatment with vasopressin antagonists (e.g. tolvaptan)
 ==Clinical Features==
-Both men and women are equally affected.  Symptoms can be present two to six days after inappropriately rapid correction of the serum sodium concentration has occurred.  Symptoms are often irreversible or only partially reversible, and include dysarthria, dysphagia, paraparesis or quadriparesis, behavioral disturbances, movement disorders, seizures, lethargy, confusion, disorientation, obtundation, and coma.  Severely affected patients may develop "locked in" syndrome. (3)
+''Symptoms can be present 2-6 days after rapid correction of serum sodium''
+*[[Dysarthria]]
-MRI can be used to visualize the pontine lesion with a characteristic "batwing" lesion of the pons appearing in typical cases.(2)
+*[[Dysphagia]]
+*Lethargy
+*Behavioral disturbances/ confusion
+*Paraparesis or quadriparesis
+*[[Seizures]]
+*"Locked in" syndrome
+*[[Coma]] and [[death]]
 ==Differential Diagnosis==
@@ Line 14: / Line 29: @@
 ==Evaluation==
+*MRI can be used to visualize the pontine lesion, with a characteristic "batwing" lesion of the pons appearing in typical cases
 ==Management==