Complete Recovery of Chronic Osmotic Demyelination Syndrome with Plasma Exchange

Introduction

Osmotic Demyelination Syndrome (ODS), formerly known as Central Pontine Myelinolysis (CPM), is a rare but serious neurological condition caused by the rapid correction of chronic hyponatremia. It can lead to severe neurological deficits, including dysarthria, dysphagia, quadriparesis, seizures, and coma. Traditionally considered irreversible, recent medical advancements suggest that Plasma Exchange (PE) may offer a promising treatment for chronic ODS.

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Case Summary

A 50-year-old female with a history of hypertension and chronic kidney disease developed ODS following the rapid correction of hyponatremia from 99 meq/L to 138 meq/L within 24 hours. Initially, she exhibited dysarthria, inability to swallow, and quadriparesis. Despite prolonged hospitalization with no improvement, PE was initiated on the 20th day after symptom onset.

Key Findings:

• Treatment Approach: The patient underwent seven cycles of PE.
• Recovery Progress: Improvement was noted after the first cycle, with gradual restoration of speech, swallowing, and limb movement.
• Final Outcome: The patient achieved complete neurological recovery and was discharged with the ability to ambulate independently.

Read the full study at https://doi.com/10.29328/journal.jcn.1001011.

The Significance of Plasma Exchange in ODS

ODS occurs due to osmotic fluctuations that disrupt the blood-brain barrier. While multiple treatment modalities, including relowering sodium levels, desmopressin (DDAVP), corticosteroids, and immunoglobulins, have been explored, none have been definitively effective. PE, commonly used for demyelinating neuropathies, has demonstrated potential benefits in reversing ODS symptoms.

The American College of Radiology (ACR) emphasizes the importance of maintaining high standards in neurological imaging to aid in early diagnosis and management of demyelinating disorders like ODS.

Clinical Implications

This case challenges the long-held belief that ODS is irreversible. A previous study reported a high mortality rate (31%) and lifelong disability (31%) in ODS patients. However, emerging evidence supports PE as a viable intervention, even in chronic cases.

For more detailed analysis, refer to our main journal article.

Conclusion

Plasma Exchange should be considered as a therapeutic option in chronic ODS cases to improve patient outcomes and reduce long-term neurological deficits.

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