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Review
. 2021 Jan 11;15(1):6.
doi: 10.1186/s13256-020-02573-9.

Effective treatment of osmotic demyelination syndrome with plasmapheresis: a case report and review of the literature

Maheshi Wijayabandara  1 , Shenal Appuhamy  2 , Praveen Weerathunga  3 , Thashi Chang  3
Affiliations
Review

Effective treatment of osmotic demyelination syndrome with plasmapheresis: a case report and review of the literature

Maheshi Wijayabandara et al. J Med Case Rep. .

Abstract

Background: Treatment options for chronic osmotic demyelination syndrome are limited to case reports and only a very few show complete recovery. We report a case of complete recovery of chronic osmotic demyelination syndrome with plasmapheresis.

Case presentation: A 43-year-old Sri Lankan man presented with fever, repeated vomiting, unsteady gait, increased tonicity of his right upper limb and paucity of speech for three days. He was treated in the local hospital with antibiotics and antivirals as per central nervous system infection. He had hyponatraemia, which was rapidly corrected with hypertonic saline from 97 to 119 mmol/L. He was transferred to our hospital because of progressive reduction of consciousness, rapidly worsening rigidity and bradykinesia of all four limbs and worsening dysarthria and bradyphrenia. Magnetic resonance imaging of the brain was compatible with osmotic demyelination syndrome. He was commenced on plasmapheresis twenty-two days after rapid correction of sodium. He regained independent mobility with complete resolution of rigidity, bradykinesia and speech dysfunction after five cycles of alternate day plasmapheresis.

Conclusion: Plasmapheresis can be considered as an effective treatment modality in chronic osmotic demyelination syndrome.

Keywords: Hyponatraemia; Osmotic demyelination; Plasmapheresis; Sri Lanka.

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Conflict of interest statement

Authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Temporal variation of serum sodium levels. The graph shows rapid sodium correction from a trough of 97 to 119 mmol/L.
Fig. 2
Fig. 2
MRI brain before plasmapheresis. a Bilateral symmetrical T2-FLAIR high signal involving caudate, lentiform nuclei, thalami and external capsules; b central trident shaped T2-FLAIR high signal area in the pons (yellow arrow).
Fig. 3
Fig. 3
Temporal variation of serum sodium levels with sodium re-lowering therapy and plasmapheresis.
Fig. 4
Fig. 4
MRI brain five months after plasmapheresis. The images shows complete resolution of changes observed in Fig. 2.
See this image and copyright information in PMC

References

    1. George JC, Zafar W, Bucaloiu ID, Chang AR. Risk factors and outcomes of rapid correction of severe hyponatremia. Clin J Am Soc Nephrol. 2018;13(7):984–992. - PMC - PubMed
    1. Lien YH, Shapiro JI, Chan L. Study of brain electrolytes and organic osmolytes during correction of chronic hyponatremia. Implications for the pathogenesis of central pontine myelinolysis. J Clin Invest. 1991;88(1):303–309. - PMC - PubMed
    1. Gankam-Kengne F, Couturier BS, Soupart A, Brion JP, Decaux G. Osmotic stress-induced defective glial proteostasis contributes to brain demyelination after hyponatremia treatment. J Am Soc Nephrol. 2017;28(6):1802–1813. - PMC - PubMed
    1. Sterns RH, Cappuccio JD, Silver SM, Cohen EP. Neurologic sequelae after treatment of severe hyponatremia: a multicenter perspective. J Am Soc Nephrol. 1994;4(8):1522–1530. - PubMed
    1. Soupart A, Ngassa M, Decaux G. Therapeutic relowering of the serum sodium in a patient after excessive correction of hyponatremia. Clin Nephrol. 1999;51(6):383–386. - PubMed

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