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Osmotic Demyelination Syndrome

RD Popova, EB Kalchev, GN Valchev, DV Kaloyanova, TG Teneva, BD Balev


INTRODUCTION: Osmotic demyelination syndrome is a state of acute demyelination due to rapid shifts in serum osmolality. The entity was formerly called central pontine myelinolysis, for the demyelination process most typically affects the central pontine white matter with sparing of the periphery. However, it can also affect the cerebral and cerebellar white matter, formerly called extrapontine myelinolysis. Predisposing conditions include alcoholism, rapid correction of hyponatremia, hypernatremia, liver failure, organ transplantation, extensive burns, malnutrition and hyperosmolar hyperglycemia.

CASE PRESENTATION: A 39-year-old, obese woman was admitted to the Regional Hospital after sudden development of abdominal pain and vomiting. She was diagnosed with incarcerated paraumbilical hernia. An emergency laparotomy was performed with resection of approximately 1.5 m partially necrotic intestine. The patient had a previous history of 2 years with polydipsia and polyuria postpartum and was diagnosed with partial diabetes insipidus. For these complaints she received medical therapy, ceased in the early postoperative period. After the operation, the patient developed progressive impairment of consciousness and a rise of sodium levels, necessitating admission to the ICU. Acute toxic-metabolic encephalopathy was suspected and rapid correction of the serum sodium was performed. A day later the patient was transported to the ICU in our hospital. The serial computed tomography (CT) examinations revealed hypodensity of the corpus callosum and the central pons. MRI was contraindicated for the presence of surgical clips.

CONCLUSION: Our patient had typical imaging findings of osmotic demyelination syndrome consisting of hypodensity in the central pontine region and in the corpus callosum.


osmotic demyelination syndrome, computed tomography

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About The Authors

RD Popova

EB Kalchev

GN Valchev

DV Kaloyanova

TG Teneva

BD Balev

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