Osmotic demyelination syndrome is a disorder characterized by wide spread development of demyelination in the pontine as well as extra pontine regions. It has been a recognized complication of rapid correction of hyponatremia. However, a variety of other conditions have been associated with the development of ODS, independent of changes in serum sodium. Here we present a patient who came with features suggestive of ODS, uncontrolled hyperglycemia and recently corrected hyponatremia.

1. Adams RD, Victor M, Mancall EL. Central Pontine Myelinolysis: A Hitherto Undescribed Disease Occurring in Alcoholic and Malnourished Patients. AMA Arch Neurol Psychiatry. 1959 Feb 1;81(2):154–72.
2. Osmotic demyelination syndrome due to hyperosmolar hyperglycemia [Internet]. [cited 2020 Jan 22]. Available from: https://www.mdedge.com/ccjm/article/168893/neurology/osmotic-demyelination-syndrome-due-hyperosmolar-hyperglycemia
3. Martin RJ. Central pontine and extrapontinemyelinolysis: the osmotic demyelination syndromes. J Neurol Neurosurg Psychiatry. 2004 Sep 1;75(suppl 3):iii22–8.
4. DeLuca G, Nagy Z, Esiri M, Davey P. Evidence for a role for apoptosis in central pontinemyelinolysis. ActaNeuropathol (Berl). 2002 Jun 1;103(6):590–8.
5. Talluri S, Charumathi R, Khan M, Kissell K. Atypical presentation of central pontinemyelinolysis in hyperglycemia. Endocrinol Diabetes Metab Case Rep [Internet]. 2017 Sep 4 [cited 2020 Jan 22];2017. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592705/
6. Sullivan AA, Chervin RD, Albin RL. Parkinsonism after correction of hyponatremia with radiological central pontinemyelinolysis and changes in the basal ganglia.J ClinNeurosci. 2000 May 1;7(3):256–9.

Aida Mary Varghese

Junior Resident, Department of General Medicine, Govt. T. D. Medical College, Alappuzha, Kerala, India