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Osmotic Demyelination SyndromeLack of Pathologic and Radiologic Imaging Correlation
David B. Clifford, MD;
Mokhtar H. Gado, MD;
Beth K. Levy, MD
Arch Neurol. 1989;46(3):343-347.
Abstract
• An otherwise healthy diabetic woman developed severe hyponatremia, her serum sodium ion levels were rapidly corrected to normal, and she had a course of improvement then neurologic deterioration, with seizures and coma developing in the subsequent two days. Imaging studies, including computed tomography and magnetic resonance images of the brain as late as 19 days after the osmotic insult, failed to show pathologically demonstrated demyelinating lesions. Osmotic brain injury induces demyelination in areas of gray-white apposition and, clinically, results in a delayed neurologic deterioration one to three days following the osmotic challenge. Even with magnetic resonance imaging, review of the literature and this experience suggest that osmotic demyelination cannot reliably be imaged during the first month after the insult.
Author Affiliations
From the Departments of Neurology and Neurological Surgery (Neurology) (Dr Clifford), Radiology (Dr Gado), and Pathology (Neuropathology) (Dr Levy), Washington University School of Medicine, St Louis.
Footnotes
Accepted for publication Feb 15, 1988.
Reprint requests to Department of Neurology and Neurological Surgery (Neurology), Washington University School of Medicine, 660 S Euclid, St Louis, MO 63110 (Dr Clifford).
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