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A difficult case
Osmotic demyelination syndrome despite appropriate gradual correction of moderate hyponatraemia
  1. Patrick Thomas Murphy,
  2. Stephen Auger,
  3. Ashwini Nandoskar
  1. Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Patrick Thomas Murphy, Department of Neurology, Imperial College Healthcare NHS Trust, London, UK; patrick.murphy9{at}nhs.net

Abstract

Osmotic demyelination syndrome characteristically follows rapid correction of hyponatraemia. We present a young woman with a subacute progressive brainstem syndrome and diffuse pontine signal abnormality on MR imaging, diagnosed as osmotic demyelination syndrome. The case posed a diagnostic challenge due to comorbid Behçet’s disease and the absence of significant fluctuation in her serum sodium concentration. Osmotic demyelination syndrome is not limited to patients with rapidly corrected hyponatraemia, especially when there are other risk factors. These factors, all present in this patient, include hypokalaemia, hypophosphataemia, malnutrition, harmful alcohol use and liver dysfunction.

  • ALCOHOL-RELATED PROBLEMS
  • LIVER DISEASE
  • BEHCET-S SYNDROME
  • BLOOD-BRAIN BARRIER

Data availability statement

Data are available upon reasonable request. We have further clinical data on electronic health records.

https://doi.org/10.1136/practneurol-2022-003369

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    Data availability statement

    Data are available upon reasonable request. We have further clinical data on electronic health records.

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    Footnotes

    • Contributors PTM wrote the first draft. SA created the figures. All authors revised the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed by Roswell Martin, Gloucester, UK.