Preprint
Interesting Images

Osmotic Demyelination Syndrome: A Rare Clinical Image

Altmetrics

Downloads

97

Views

35

Comments

0

A peer-reviewed article of this preprint also exists.

Submitted:

31 August 2023

Posted:

05 September 2023

You are already at the latest version

Alerts
Abstract
The term "Osmotic Demyelination Syndrome" (ODS) is synonymous with central pontine myelinolysis (CPM), denoting a condition characterized by brain damage, particularly affecting the white matter tracts of the pontine region. This damage arises due to rapid correction of metabolic imbalances, primarily cases of hyponatremia. Noteworthy triggers encompass severe burns, liver transplantations, anorexia nervosa, hyperemesis gravidarum, and hyperglycaemia, all linked to the development of CPM. Clinical manifestations encompass a spectrum of signs and symptoms, including dysphagia, dysarthria, spastic quadriparesis, pseudobulbar paralysis, ataxia, lethargy, tremors, disorientation, catatonia, and, in severe instances, locked-in syndrome and coma. A recent case involving a 45-year-old woman illustrates these complexities. Upon admission to the Medicine Intensive Care Unit, she presented with symptoms indicative of diminished responsiveness and bilateral weakness in upper and lower limbs. Of significance, the patient had a pre-existing medical history of hyperthyroidism. Extensive diagnostic investigations were undertaken, revealing compelling evidence of profound hyponatremia through blood analyses. Furthermore, magnetic resonance imaging (MRI) was performed, unveiling conspicuous areas of abnormal hyperintensity located in the central pons, intriguingly accompanied by spared peripheral regions. These radiological findings align with the characteristic pattern associated with osmotic demyelination syndrome, illuminating the underlying pathology.
Keywords: 
Subject: Public Health and Healthcare  -   Physical Therapy, Sports Therapy and Rehabilitation
Figures. Magnetic Resonance Imaging: - (A) Hyper-intensity of central pons in diffuse weighted image (orange arrow) [1]; (B) Trident-shaped appearance (omega sign) of central pons in T2 weighted image (blue arrow) [2]; (C), (D) Piglet sign appearance of upper pons in T2 and FLAIR images (green and red circles respectively) [3].
Figures. Magnetic Resonance Imaging: - (A) Hyper-intensity of central pons in diffuse weighted image (orange arrow) [1]; (B) Trident-shaped appearance (omega sign) of central pons in T2 weighted image (blue arrow) [2]; (C), (D) Piglet sign appearance of upper pons in T2 and FLAIR images (green and red circles respectively) [3].
Preprints 83908 g001aPreprints 83908 g001b

Author Contributions

P.K. was responsible for formulating, writing, and preparing the original draft of the manuscript. All authors conducted the review and editing process as well. The final version of the manuscript was read and approved by the author.

Funding

The current study got no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Written consent was obtained from the patient's caregivers.

Conflict of Interest

The authors declare no conflict of interest.

References

  1. Ruzek, K.A.; Campeau, N.G.; Miller, G.M. Early Diagnosis of Central Pontine Myelinolysis with Diffusion-Weighted Imaging. American Journal of Neuroradiology 2004, 25, 210–213. [Google Scholar] [PubMed]
  2. Miller, G.M.; Baker, H.L.; Okazaki, H.; Whisnant, J.P. Central Pontine Myelinolysis and Its Imitators: MR Findings. Radiology 1988, 168, 795–802. [Google Scholar] [CrossRef]
  3. Beh, S.C. Temporal Evolution of the Trident and Piglet Signs of Osmotic Demyelination Syndrome. Journal of the Neurological Sciences 2017, 373, 268–273. [Google Scholar] [CrossRef] [PubMed]
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.
Copyright: This open access article is published under a Creative Commons CC BY 4.0 license, which permit the free download, distribution, and reuse, provided that the author and preprint are cited in any reuse.
Prerpints.org logo

Preprints.org is a free preprint server supported by MDPI in Basel, Switzerland.

Subscribe

© 2024 MDPI (Basel, Switzerland) unless otherwise stated