User:Mr. Ibrahem/Osmotic demyelination syndrome

Osmotic demyelination syndrome, previously known as central pontine myelinolysis, is damage to certain regions of the brain following rapid correction of electrolyte disorders. Symptoms may include difficulty swallowing, difficulty speaking, movement disorders, decreased level of consciousness, and paralysis. Other complications may include seizures and locked in syndrome. Onset is within a day to two weeks of a trigger.

It most commonly occurs as a complication of low sodium, particularly severely low sodium and its correction by more than 12 mmol/L in a day. Other potential causes include low potassium, high sodium, low phosphate, liver transplantation, high blood sugar, and kidney failure. Risk factors include alcoholism and malnutrition. The underlying mechanism involves a rapid rise in serum tonicity leading to demyelination of white matter. While the initial cases described the pons being affected, other areas of the brain have also found to be involved. Diagnosis is suspected based on symptoms and confirmed by MRI.

Prevention is by correcting low sodium at a rate of less than 0.5 mmol/L per hour. Once the condition has developed there is no specific treatment, though immunotherapy and vaptans may be tried. Poor outcomes occur in a third to half of those effected. The risk of death is 10 to 60%.

Osmotic demyelination syndrome is rare in the general population, though may affect up to 30% of at risk groups. It most commonly occurs in those between the age of 30 and 50. Males are more commonly affected than females. It was first described by Adams in 1959.