P.035 Impressive MRI findings in the case of iatrogenic osmotic demyelination syndrome: case report

Abstract

Background: Osmotic demyelination syndrome (ODS) is a known complication of rapid sodium correction. While the pons is classically the most vulnerable region to osmotic shifts, other structures may also be affected. Prognosis varies from death to full recovery, yet we cannot accurately predict a patient’s outcome in the acute phase. Methods: Patient chart, medical imaging, and laboratory findings were reviewed. Results: Here we present the case of a 57-year-old woman seen at our center, who was transferred from a community hospital in the context of ODS after having her serum sodium corrected from 106 mmol/L to 122 mmol/L within 24 hours. She showed depressed mental status, bulbar symptoms, ataxia and respiratory compromise, eventually requiring transfer to the intensive care unit for intubation. MRI of the brain showed striking demyelinating injury at the level of the pons. The patient was discharged to a rehabilitation facility, eventually achieving independence in activities of daily living. Conclusions: This case illustrates canonical neuroimaging findings associated with ODS. Despite extensive initial damage, long-term disability can be mitigated with appropriate care. Future studies seeking to identify specific markers imaging and clinical markers would be of interest to predict functional outcome.