Clinical Characteristics And Prognosis Of Osmotic Demyelination Syndrome (Analysis Of Thirteen Cases)

Background:Osmotic demyelination syndrome(ODS)is a rare central nervous system disorder characterized by non-inflammatory,symmetrical myelin damage.the past,there was a lot of understanding of Central pontine myelinolysis(CPM),and the incidence of Extrathoracic myelinolysis(EPM)is now increasing.In clinical work and literature reports,the most common cause of ODS is the rapid correction of hyponatremia.The pathophysiological mechanism of this process has been confirmed in animal experiments.The other two major causes are alcohol and liver transplantation.Rear.Later,with the deepening of understanding of ODS,a variety of other rare causes were gradually reported,including renal failure,diabetes,hypokalemia,hyperemesis of pregnancy,severe burns and postoperative pituitary tumors.The clinical manifestations of ODS are many and complex.Magnetic resonance imaging(MRI)is the main method for clinical diagnosis.It is sensitive to the detection of lesions in the early stage of the disease.However,at present,there is no clear and unified diagnostic standard for ODS.The previous literature is mainly based on case reports,and there is a lack of large-sample data research.Therefore,it is necessary to improve the understanding of the clinical department,which is especially important for the early prevention,identification,diagnosis and treatment of ODS.Objective:To analyze and discuss the causes of Osmotic demyelinating syndrome(ODS),prominent clinical manifestations,imaging features,and risk factors associated with prognosis.Subjects and Methods:Prospectively collected 13 cases of Osmotic demyelinating syndrome(ODS)diagnosed by head MRI of the First Affiliated Hospital of Zhengzhou University from January 2017 to June 2018,including 5 cases of CPM,5 cases of EPM,and 3 cases of CPM combined with EPM.The clinical data of 13 patients during hospitalization and the follow-up of 6 months after discharge were summarized,evaluated and statistically analyzed.Results:Among the 13 cases patients with ODS,7 cases were male and 6 cases were female,with an average age of 56.23±13.62 years.Clinical data of patients: 7 cases were end-stage renal disease,2 cases had long-term alcohol abuse history,2 cases were diabetes,1 case had long-term application history of diuretic drugs,and 1 case was pregnant women.All patients had abnormal changes in plasma osmotic pressure,10 cases(76.9%)were rapidly corrected after hyponatremia,2 cases(15.4%)were hyperosmolar hyperglycemia syndrome,and the remaining 1 cases(7.7%)were hypokalemia.Blood.Two of the patients developed hyperosmolar hyperglycemia to EPM,which was characterized by acute Parkinson-like symptoms in the short term,which is a rare condition(46.2%),disturbance of consciousness(38.5%)and bulbar palsy(38.5%)were the most common clinical symptoms of ODS,followed by secondary Parkinson's syndrome(30.8%).Patients with CPM and EPM have complex clinical manifestations,and various symptoms such as disturbance of consciousness,paralysis,mental disorders,seizures,and ataxia can exist.The development rate of the lesion on the head magnetic resonance(MRI)was highest within 4-10 days after the onset of neurological symptoms.The most common sites of involvement were pons(61.5%),caudate nucleus(61.5%)and lenticular nucleus(46.2%).The treatment plan of 13 cases patients was mainly to control the abnormal changes of plasma osmotic pressure,such as reasonable maintenance of water and electrolyte balance and control of blood sugar,while paying attention to active treatment of primary disease.Secondary Parkinson's syndrome occurred in some patients with EPM,and the symptoms were significantly improved after treatment with Madopar,but one patient developed chorea after late follow-up,and 4 cases patients had prognosis due to pulmonary infection and acute renal failure.Poor,the remaining 9 cases patients had a good prognosis,and the overall prognosis of EPM was better than CPM.The prognosis of the two patients was worse than the former two.Conclusion:In patients with metabolic abnormalities or poor nutritional status,electrolyte or abnormal blood glucose is a precursor to risk factors for ODS,such as end-stage renal disease and hypertensive hyperglycemia in patients with diabetes,which should be corrected as soon as possible.The most common clinical symptoms of CPM are disturbance of consciousness,delirium and medullary paralysis,while EPM is most common with Parkinson-like symptoms.When clinically highly suspected ODS,attention should be paid to imaging examination within 4-10 days after onset.The most common lesions are located in the pons and basal ganglia,showing a symmetric distribution.If ODS is diagnosed and treated early,the clinical outcome may be better.The overall prognosis of EPM is better than CPM.The condition is reversible after early administration.Pay attention to avoid acute exacerbation of primary disease and clinical complications,thus affecting prognosis.