Osmotic demyelination syndrome - case reports

Osmotic demyelination syndrome (ODS) is one of the dreaded complications encountered during management of chronic hyponatremia. Rapid osmotic shift of fluid during correction of hyponatremia results in osmotic myelinolysis of the pontine or extrapontine areas of the brain. Even gradual correction of hyponatraemia can produce myelinolyis, especially with pre-existing malnourishment, alcoholism, drug abuse and Addison's disease as noted in our cases. We report two cases of demyelination, one with pontine and extra-pontine myelinolysis in the presence of chronic kidney disease on haemodialysis, and a case of extra-pontine myelinolysis due to treatment of Adrenomyeloneuropathy presenting as Addison’s disease, with good recovery on treatment with steroids.