A Case of Osmotic Demyelination Syndrome after Hemodialysis Treatment in a Uremic Patient with Severe Hyperosmolality.
- Author:
Hyun Hee KANG
1
;
Joo Yong SONG
;
Na Ri YOUN
;
Kwi Young KANG
;
Young Soo KIM
;
Sun Ae YOON
;
Young Joo KIM
;
Young Ok KIM
Author Information
1. Departments of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. cmckyo@catholic.ac.kr
- Publication Type:Case Report
- Keywords:
Osmotic demyelination syndrome;
Uremia;
Hemodialysis
- MeSH:
Aged;
Brain;
Consciousness;
Creatinine;
Demyelinating Diseases*;
Dialysis;
Dyspnea;
Edema;
Humans;
Hyponatremia;
Magnetic Resonance Imaging;
Male;
Nitrogen;
Pons;
Reference Values;
Renal Dialysis*;
Renal Replacement Therapy;
Sepsis;
Sodium;
Thalamus;
Urea;
Uremia
- From:Korean Journal of Nephrology
2006;25(6):1035-1039
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Osmotic demyelination syndrome (ODS) is a distinctive clinical syndrome with characteristic MR features in the central pons (central pontine myelinolysis) and in other brain locations (extrapontine myelinolysis). Rapid correction of hyponatremia is associated with ODS, but hyperosmolality rarely causes it. Here we report a case of ODS developed in a hemodialysis patient with severe uremia and concomitant hyperosmolality. A 67-year-old male was presented with general weakness and dyspnea. Laboratory findings showed severe uremia (blood urea nitrogen, 167 mg/dL; serum creatinine, 15 mg/dL), hyperosmolality (336 mOsm/kg H2O), and normal range of sodium (145 mEq/L). After the first hemodialysis treatment, his consciousness was changed to lethargic state. We initially suspected dialysis disequilibrium syndrome, but the symptoms were aggravated. MRI showed edema in central pons and symmetrical extrapotine lesions in the subcortical white matter, lateral thalamus, and posterior capsule, consistent with ODS. In spite of aggressive measures including continuous renal replacement therapy, he died of sepsis at the 26th hospital day.
