Introduction: Osmotic demyelination syndrome (ODS) is a non-inflammatory demyelination of neurons due to apoptosis of oligodendrocytes and the infiltration of macrophages that degrade myelin. It has a prevalence of about 0.06% in hospitalized patients, which can lead to severe disability or death. It can be precipitated by aggressive correction of a hyper or hypo osmolar condition.
Clinical Case: We present the case of a 52-year-old male patient with a history of hypertension, dyslipidemia, depression, neck pain and low back pain under treatment with desvenlafaxine, gabapentin, oxycodone-naloxone, dexketoprofen, metamizole, diazepam, ezetimibe-atorvastatin, enalapril who presented low level of consciousness and tonic-clonic seizures. In the initial examination he was in a post-critical state and scored 7 points on the Glasgow scale. In the analysis he presented hyponatremia. After correction, his neurological status progressively deteriorated, with a brain magnetic resonance imaging showing a hyperintense lesion in the pons and left temporal region compatible with ODS. Immunoglobulins were administered and subsequently, 7 plasmapheresis sessions were performed. No clinical improvement was evident with the administration of immunoglobulins. Neurological improvement was presented after 7 plasmapheresis sessions.
Conclusion: Osmotic demyelization syndrome constitutes a clinical challenge for its diagnosis, and should be suspected in patients who present new neurological symptoms after correction of serum sodium levels. There are currently no guidelines for optimal treatment. However, in some cases good results have been reported with the administration of immunoglobulins or plasmapheresis.
