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Brain
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Pathology-Based Diagnoses
Acquired Toxic/Metabolic/Degenerative Disorders
Toxic, Metabolic, Nutritional, Systemic Diseases With CNS Manifestations
Osmotic Demyelination Syndrome
Osmotic Demyelination Syndrome
Miral D. Jhaveri, MD, MBA
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Osmotic demyelination syndrome (ODS)

            • Synonyms

              • Formerly called central pontine myelinolysis (CPM) &/or extrapontine myelinolysis (EPM)

            • Definitions

              • Acute demyelination caused by rapid shifts in serum osmolality
              • Classic setting: Rapid correction of hyponatremia
                • ODS may occur in normonatremic patients

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Cheo SW et al: Trident sign in osmotic demyelination syndrome. QJM. 113(2):131-2, 2020
                                          2. Danyalian A et al: Central pontine myelinolysis, 2020
                                          3. Bansal LR et al: Osmotic demyelination syndrome in children. Pediatr Neurol. 97:12-7, 2019
                                          4. Garg P et al: Osmotic demyelination syndrome - evolution of extrapontine before pontine myelinolysis on magnetic resonance Imaging. J Neurosci Rural Pract. 10(1):126-35, 2019
                                          5. Lambeck J et al: Central pontine myelinosis and osmotic demyelination syndrome. Dtsch Arztebl Int. 116(35-36):600-6, 2019
                                          6. Shah P et al: More haste, less speed: hyponatraemia and osmotic demyelination. Lancet. 392(10160):2213, 2018
                                          7. Buffington MA et al: Hyponatremia: a review. J Intensive Care Med. 31(4):223-3, 2015
                                          8. Alleman AM: Osmotic demyelination syndrome: central pontine myelinolysis and extrapontine myelinolysis. Semin Ultrasound CT MR. 35(2):153-9, 2014
                                          9. Harring TR et al: Disorders of sodium and water balance. Emerg Med Clin North Am. 32(2):379-401, 2014
                                          10. Landais A: Central pontine myelinolysis without electrolyte disorder, alcoholism or denutrition. J Neurol Sci. 343(1-2):235-6, 2014
                                          11. Singh TD et al: Central pontine and extrapontine myelinolysis: a systematic review. Eur J Neurol. 21(12):1443-50, 2014
                                          12. de Souza A: Movement disorders and the osmotic demyelination syndrome. Parkinsonism Relat Disord. 19(8):709-16, 2013
                                          13. Popescu BF et al: Evidence of aquaporin involvement in human central pontine myelinolysis. Acta Neuropathol Commun. 1(1):40, 2013
                                          14. Verbalis JG et al: Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 126(10 Suppl 1):S1-42, 2013
                                          15. Vaidya C et al: Management of hyponatremia: providing treatment and avoiding harm. Cleve Clin J Med. 77(10):715-26, 2010
                                          16. Zeidel ML: Hyponatremia: mechanisms and newer treatments. Endocr Pract. 16(5):882-7, 2010
                                          17. de Morais BS et al: Central pontine myelinolysis after liver transplantation: is sodium the only villain? Case report. Rev Bras Anestesiol. 59(3):344-9, 2009
                                          18. Howard SA et al: Best cases from the AFIP: osmotic demyelination syndrome. Radiographics. 29(3):933-8, 2009
                                          19. Mount DB: The brain in hyponatremia: both culprit and victim. Semin Nephrol. 29(3):196-215, 2009
                                          20. Roh JH et al: Cortical laminar necrosis caused by rapidly corrected hyponatremia. J Neuroimaging. 19(2):185-7, 2009
                                          21. Ruiz S et al: [Severe hyponatraemia and central pontine myelinolysis: be careful with other factors!.] Ann Fr Anesth Reanim. 28(1):96-9, 2009
                                          22. Fong CS: [Neurological complications in uremia.] Acta Neurol Taiwan. 17(2):117-26, 2008
                                          23. Hoshino Y et al: [Pontine hemorrhage in a patient with type 1 renal tubular acidosis associated with osmotic demyelination syndrome.] Brain Nerve. 60(9):1061-5, 2008
                                          24. Laczi F: [Etiology, diagnostics and therapy of hyponatremias.] Orv Hetil. 149(29):1347-54, 2008
                                          25. Zamboli P et al: [Hyponatremia secondary to inappropriate antidiuretic hormone secretion.] G Ital Nefrol. 25(5):554-61, 2008
                                          26. Guo Y et al: Central pontine myelinolysis after liver transplantation: MR diffusion, spectroscopy and perfusion findings. Magn Reson Imaging. 24(10):1395-8, 2006
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Osmotic demyelination syndrome (ODS)

                                                    • Synonyms

                                                      • Formerly called central pontine myelinolysis (CPM) &/or extrapontine myelinolysis (EPM)

                                                    • Definitions

                                                      • Acute demyelination caused by rapid shifts in serum osmolality
                                                      • Classic setting: Rapid correction of hyponatremia
                                                        • ODS may occur in normonatremic patients

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Nuclear Medicine Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Cheo SW et al: Trident sign in osmotic demyelination syndrome. QJM. 113(2):131-2, 2020
                                                                                  2. Danyalian A et al: Central pontine myelinolysis, 2020
                                                                                  3. Bansal LR et al: Osmotic demyelination syndrome in children. Pediatr Neurol. 97:12-7, 2019
                                                                                  4. Garg P et al: Osmotic demyelination syndrome - evolution of extrapontine before pontine myelinolysis on magnetic resonance Imaging. J Neurosci Rural Pract. 10(1):126-35, 2019
                                                                                  5. Lambeck J et al: Central pontine myelinosis and osmotic demyelination syndrome. Dtsch Arztebl Int. 116(35-36):600-6, 2019
                                                                                  6. Shah P et al: More haste, less speed: hyponatraemia and osmotic demyelination. Lancet. 392(10160):2213, 2018
                                                                                  7. Buffington MA et al: Hyponatremia: a review. J Intensive Care Med. 31(4):223-3, 2015
                                                                                  8. Alleman AM: Osmotic demyelination syndrome: central pontine myelinolysis and extrapontine myelinolysis. Semin Ultrasound CT MR. 35(2):153-9, 2014
                                                                                  9. Harring TR et al: Disorders of sodium and water balance. Emerg Med Clin North Am. 32(2):379-401, 2014
                                                                                  10. Landais A: Central pontine myelinolysis without electrolyte disorder, alcoholism or denutrition. J Neurol Sci. 343(1-2):235-6, 2014
                                                                                  11. Singh TD et al: Central pontine and extrapontine myelinolysis: a systematic review. Eur J Neurol. 21(12):1443-50, 2014
                                                                                  12. de Souza A: Movement disorders and the osmotic demyelination syndrome. Parkinsonism Relat Disord. 19(8):709-16, 2013
                                                                                  13. Popescu BF et al: Evidence of aquaporin involvement in human central pontine myelinolysis. Acta Neuropathol Commun. 1(1):40, 2013
                                                                                  14. Verbalis JG et al: Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 126(10 Suppl 1):S1-42, 2013
                                                                                  15. Vaidya C et al: Management of hyponatremia: providing treatment and avoiding harm. Cleve Clin J Med. 77(10):715-26, 2010
                                                                                  16. Zeidel ML: Hyponatremia: mechanisms and newer treatments. Endocr Pract. 16(5):882-7, 2010
                                                                                  17. de Morais BS et al: Central pontine myelinolysis after liver transplantation: is sodium the only villain? Case report. Rev Bras Anestesiol. 59(3):344-9, 2009
                                                                                  18. Howard SA et al: Best cases from the AFIP: osmotic demyelination syndrome. Radiographics. 29(3):933-8, 2009
                                                                                  19. Mount DB: The brain in hyponatremia: both culprit and victim. Semin Nephrol. 29(3):196-215, 2009
                                                                                  20. Roh JH et al: Cortical laminar necrosis caused by rapidly corrected hyponatremia. J Neuroimaging. 19(2):185-7, 2009
                                                                                  21. Ruiz S et al: [Severe hyponatraemia and central pontine myelinolysis: be careful with other factors!.] Ann Fr Anesth Reanim. 28(1):96-9, 2009
                                                                                  22. Fong CS: [Neurological complications in uremia.] Acta Neurol Taiwan. 17(2):117-26, 2008
                                                                                  23. Hoshino Y et al: [Pontine hemorrhage in a patient with type 1 renal tubular acidosis associated with osmotic demyelination syndrome.] Brain Nerve. 60(9):1061-5, 2008
                                                                                  24. Laczi F: [Etiology, diagnostics and therapy of hyponatremias.] Orv Hetil. 149(29):1347-54, 2008
                                                                                  25. Zamboli P et al: [Hyponatremia secondary to inappropriate antidiuretic hormone secretion.] G Ital Nefrol. 25(5):554-61, 2008
                                                                                  26. Guo Y et al: Central pontine myelinolysis after liver transplantation: MR diffusion, spectroscopy and perfusion findings. Magn Reson Imaging. 24(10):1395-8, 2006