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Osmotic Demyelination Syndrome Symptoms, Causes, Treatment

Osmotic demyelination syndrome is also known as central pontine myelionysis CPM. It is a neurological condition in which patient suffers from over correction and rapid correction of decreased or low sodium level in serum. Patient with osmotic demyelination syndrome may also have acute paralysis, dysphagia, dysarthria and some other neurological symptoms. Basically it occur due to damage in myelin sheath of nerve cells, located in the area of pons. Myelin sheath got lesion and as a result this syndrome occurs.

Patient with osmotic demyelination syndrome have sodium concentration 120 meq per liter or less in serum which can be corrected at a rate not more than 10 mmol/L/24 h. It is also said that, osmotic demyelination syndrome is a treatment complication of a condition named hyponatremia. The presentation of osmotic demyelination is heterogeneous it shows symptoms on the basis of brain region involved. It may occur due to many reasons like alcoholism, burns, dialysis and hypokalemia etc. computed tomography scan and magnetic resonance imaging test are performed to diagnose osmotic demyelination syndrome. Its acute symptoms take about some days or even week to develop so its diagnosis may be late. Magnetic resonance imaging technique show changes more accurately as compare to computed tomography scan.


Osmotic Demyelination Syndrome Symptoms

       
Symptoms occurring in osmotic demyelination syndrome totally depend on the area of brain involved. Before occurrence of this syndrome patient may show symptoms of hyponatraemic encephalopathy like vomiting, nausea, headache, confusion and seizures. These symptoms can be recovered by making serum sodium level up to normal concentration. After few days, symptoms of osmotic demyelination start occurring i.e. seizures, changes in gait, ceased or decreased respiratory function and disturbed consciousness. There may be other symptoms but those will be associated with further damage in myelin sheath of brain stem.

Osmotic Demyelination Syndrome Symptoms, Causes, Treatment

Osmotic Demyelination Syndrome Causes


There may be many causes behind osmotic demyelination syndrome but the main reason is hyponatremia. Some causes other than hyponatremia are as follows:

  • It may be associated with hypokalemia, anorexia nervosa, severe burns, and dialysis.
  • Excessive alcohol consumption for long term is another main cause.
  • It may be secondary to some medications which can cross blood brain barrier. As these drugs pass brain barrier, it start causing abnormal thirst reception. In this case polydipsia is a leading cause behind occurrence of osmotic demyelination syndrome.
  • Psychogenic polydipsia in schizophrenic patients also cause osmotic demyelination syndrome by increasing thirst and decreasing sodium level.

Osmotic Demyelination Syndrome Treatment

       
Osmotic demyelination syndrome occurs due to decreased sodium concentration in blood so this sodium concentration need attention to treat osmotic demyelination syndrome. So sodium level in serum should be leveled at a rate not exceeding 10 mmol per liter per 24 hours. Or 0.5 meq per liter per hour or 18 meq per liter per 48 hours. Alcoholic patients are advised to not take vitamin supplements. Once this syndrome occur no treatment can cure it completely so preventive measures should be followed and care is required. Animal studies shows that inositol reduces osmotic demyelination syndrome severity.
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