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Osmotic demyelination syndrome due to rapid fluctuations in serum sodium - a case report

RAMYA LAKSHMINARASIMHAN

Abstract


Demyelination of the neural structures
can occur due to rapid correction of
chronic hyponatremia, and the diagnosis
can now be made by radiological demonstration
of hyperintense signals on T2
weighted MRI sequences. This is a case
report of a 13 year old boy with a craniopharyngioma
who underwent a transcranial
radical excision of the tumour. Postoperatively
he developed diabetes insipidus
with a wide fluctuation in the serum
sodium levels despite management
with intravenous fluids and pitressin analogues.
He developed spastic paresis of
all 4 limbs with preservation of only vertical
eye movements, suggestive of a
locked in syndrome. MRI brain showed
hyperintense signals within the brainstem
and the basal ganglia with no mass effect.
A diagnosis of osmotic demyelination
was made, and the patient gradually
recovered with supportive care over a
period of 3 months.


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