Korean J Nephrol.  2006 Nov;25(6):1035-1039.

A Case of Osmotic Demyelination Syndrome after Hemodialysis Treatment in a Uremic Patient with Severe Hyperosmolality

• Kang HH
• Song JY
• Youn NR
• Kang KY
• Kim YS
• Yoon SA
• Kim YJ
• Kim YO

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.

Keyword

Osmotic demyelination syndrome; Uremia; Hemodialysis

MeSH Terms

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
Creatinine
Nitrogen
Sodium
Urea