Osmotic demyelination syndrome with a dysequilibrium syndrome: reversible MRI findings

Abstract

Neurological disorders may be seen in end-stage renal disease patients due to uraemia or to complications of dialysis. A dysequilibrium syndrome may be seen, usually soon after or towards the end of haemodialysis. This group of patients has no particular findings on MRI. On the other hand, the osmotic demyelination syndrome has definitive MRI findings, not to date reported with the dysequilibrium syndrome. We report a patient with end-stage renal disease and the dysequilibrium syndrome who showed findings of osmotic demyelination on MRI. The patient had a convulsion after a first haemodialysis, with quadriparesis and hyperactive deep tendon reflexes and bilateral Babinski signs. The upper motor neurone signs lasted for a week. Meanwhile, he was also dysarthric and had dysphagia. He recovered neurologically without any residuum following appropriate treatment and there was improvement on MRI.

Widespread White Matter Alterations in Patients with End-Stage Renal Disease: A Voxelwise Diffusion Tensor Imaging Study

“…19 Unlike cognitive function, white matter alterations in the infratentorial regions after hemodialysis were only discussed in a few studies using conventional MR imaging. [20][21][22] Dialysis disequilibrium syndrome, first described in 1962 by Kennedy et al, 3 is commonly described as an acute neurologic disorder that occurs in patients undergoing hemodialysis. In addition, osmotic demyelination syndrome, which has been observed in patients with ESRD, is characterized by transient edema and demyelination in the pons and extrapontine regions after hemodialysis.…”

Central Pontine Lesions Observed with MRI in Four Diabetic Patients

“…All the pontine (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16), but renal dysfunction is present when a description is given (1,7,10,12). In cases reported as CPM/ ODS, all patients have diabetes mellitus (17)(18)(19)(20)(21)(22)(23) or renal dysfunction (24,25). Information on blood pressure was not given in all cases, but the available data (17,20,22,24) (25).…”

“…In cases reported as CPM/ ODS, all patients have diabetes mellitus (17)(18)(19)(20)(21)(22)(23) or renal dysfunction (24,25). Information on blood pressure was not given in all cases, but the available data (17,20,22,24) (25). In such cases, greater osmotic shifts and over-hydration may occur and are likely to induce brain edema (25,27) (34), and is considered to be an important factor in the development of CPM (35).…”

Diffuse Leukoencephalopathy Associated with Dialysis Disequilibrium Syndrome

“…As reversible cerebral white matter diseases associated with DDS, osmotic demyelination syndrome (ODS) (6, 7) and posterior reversible encephalopathy syndrome (PRES) (2,8) have been known. ODS is a demyelinating disorder caused by the rapid increase of sodium in hyponatremia, chronic alcoholism, malnutrition, and chronic liver disease (6). White matter lesions have been thought to represent a combination of edema and demyelination (7).…”