Open AccessTreatment response in osmotic demyelination syndrome presenting as severe parkinsonism, ptosis and gaze palsy
Author(s) -
Sanihah Abdul Halim,
Nur Aida Mohd Amin
Publication year - 2018
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-225751
Subject(s) - medicine , ptosis , central pontine myelinolysis , parkinsonism , pons , diplopia , dexamethasone , pediatrics , surgery , anesthesia , disease , hyponatremia
Osmotic demyelination syndrome commonly affects the pons and infrequently involves the extrapontine region. We report a patient with severe hyponatraemia who developed osmotic demyelination syndrome as a consequence of rapid sodium correction. The condition manifested as acute severe parkinsonism, bilateral ptosis and gaze impairment. MRI revealed typical features of central pontine and extrapontine myelinolysis. The patient improved gradually after treatment with a combination of levodopa, intravenous immunoglobulin and dexamethasone. However, it is important to emphasise that the improvement of neurological symptoms is not necessarily causal with these experimental therapies.