Osmotic Demyelination Syndrome as the Initial Manifestation of a Hyperosmolar Hyperglycemic State

Osmotic demyelination syndrome (ODS) is a life-threatening demyelinating syndrome. The association of ODS with hyperosmolar hyperglycemic state (HHS) has been seldom reported. The aim of this study was to present and discuss previous cases and the pathophysiological mechanisms involved in ODS second...

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Main Authors:	Rodríguez-Velver, Karla Victoria, Soto-Garcia, Analy J., Zapata-Rivera, María Azucena, Montes-Villarreal, Juan, Villarreal-Pérez, Jesús Zacarías, Rodríguez-Gutiérrez, René
Format:	Online
Language:	English
Published:	Hindawi Publishing Corporation 2014
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241748/

id	pubmed-4241748
recordtype	oai_dc
spelling	pubmed-42417482014-11-27 Osmotic Demyelination Syndrome as the Initial Manifestation of a Hyperosmolar Hyperglycemic State Rodríguez-Velver, Karla Victoria Soto-Garcia, Analy J. Zapata-Rivera, María Azucena Montes-Villarreal, Juan Villarreal-Pérez, Jesús Zacarías Rodríguez-Gutiérrez, René Case Report Osmotic demyelination syndrome (ODS) is a life-threatening demyelinating syndrome. The association of ODS with hyperosmolar hyperglycemic state (HHS) has been seldom reported. The aim of this study was to present and discuss previous cases and the pathophysiological mechanisms involved in ODS secondary to HHS. A 47-year-old man arrived to the emergency room due to generalized tonic-clonic seizures and altered mental status. The patient was lethargic and had a Glasgow coma scale of 11/15, muscle strength was 4/5 in both lower extremities, and deep tendon reflexes were diminished. Glucose was 838 mg/dL; serum sodium and venous blood gas analyses were normal. Urinary and plasma ketones were negative. Brain magnetic resonance revealed increased signal intensity on T2-weighted FLAIR images with restricted diffusion on the medulla and central pons. Supportive therapy was started and during the next 3 weeks the patient progressively regained consciousness and muscle strength and was able to feed himself. At 6-month follow-up, the patient was asymptomatic and MRI showed no residual damage. In conclusion, the association of ODS with HHS is extremely rare. The exact mechanism by which HHS produces ODS still needs to be elucidated, but we favor a rapid hypertonic insult as the most plausible mechanism. Hindawi Publishing Corporation 2014 2014-11-09 /pmc/articles/PMC4241748/ /pubmed/25431711 http://dx.doi.org/10.1155/2014/652523 Text en Copyright © 2014 Karla Victoria Rodríguez-Velver et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Rodríguez-Velver, Karla Victoria Soto-Garcia, Analy J. Zapata-Rivera, María Azucena Montes-Villarreal, Juan Villarreal-Pérez, Jesús Zacarías Rodríguez-Gutiérrez, René
spellingShingle	Rodríguez-Velver, Karla Victoria Soto-Garcia, Analy J. Zapata-Rivera, María Azucena Montes-Villarreal, Juan Villarreal-Pérez, Jesús Zacarías Rodríguez-Gutiérrez, René Osmotic Demyelination Syndrome as the Initial Manifestation of a Hyperosmolar Hyperglycemic State
author_facet	Rodríguez-Velver, Karla Victoria Soto-Garcia, Analy J. Zapata-Rivera, María Azucena Montes-Villarreal, Juan Villarreal-Pérez, Jesús Zacarías Rodríguez-Gutiérrez, René
author_sort	Rodríguez-Velver, Karla Victoria
title	Osmotic Demyelination Syndrome as the Initial Manifestation of a Hyperosmolar Hyperglycemic State
title_short	Osmotic Demyelination Syndrome as the Initial Manifestation of a Hyperosmolar Hyperglycemic State
title_full	Osmotic Demyelination Syndrome as the Initial Manifestation of a Hyperosmolar Hyperglycemic State
title_fullStr	Osmotic Demyelination Syndrome as the Initial Manifestation of a Hyperosmolar Hyperglycemic State
title_full_unstemmed	Osmotic Demyelination Syndrome as the Initial Manifestation of a Hyperosmolar Hyperglycemic State
title_sort	osmotic demyelination syndrome as the initial manifestation of a hyperosmolar hyperglycemic state
description	Osmotic demyelination syndrome (ODS) is a life-threatening demyelinating syndrome. The association of ODS with hyperosmolar hyperglycemic state (HHS) has been seldom reported. The aim of this study was to present and discuss previous cases and the pathophysiological mechanisms involved in ODS secondary to HHS. A 47-year-old man arrived to the emergency room due to generalized tonic-clonic seizures and altered mental status. The patient was lethargic and had a Glasgow coma scale of 11/15, muscle strength was 4/5 in both lower extremities, and deep tendon reflexes were diminished. Glucose was 838 mg/dL; serum sodium and venous blood gas analyses were normal. Urinary and plasma ketones were negative. Brain magnetic resonance revealed increased signal intensity on T2-weighted FLAIR images with restricted diffusion on the medulla and central pons. Supportive therapy was started and during the next 3 weeks the patient progressively regained consciousness and muscle strength and was able to feed himself. At 6-month follow-up, the patient was asymptomatic and MRI showed no residual damage. In conclusion, the association of ODS with HHS is extremely rare. The exact mechanism by which HHS produces ODS still needs to be elucidated, but we favor a rapid hypertonic insult as the most plausible mechanism.
publisher	Hindawi Publishing Corporation
publishDate	2014
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241748/
_version_	1613160055164633088

Osmotic Demyelination Syndrome as the Initial Manifestation of a Hyperosmolar Hyperglycemic State

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