Osmotic demyelination is a complication caused by rapid electrolyte correction, leading to myelin sheath deterioration. Symptoms depend on the affected neurons, and there is no cure. Treatment involves symptomatic relief and physical therapy. It is a medical emergency, and diagnostic tests pinpoint the affected area. The condition can occur in the brain and spine, and recovery depends on the location of the impairment.
Osmotic demyelination can occur as a complication when patients undergo rapid correction of the electrolyte imbalance, which causes the myelin sheath to deteriorate. The risk of this happening increases when patients have underlying medical conditions such as burns, chronic alcoholism or malnutrition. The symptoms of osmotic demyelination depend on which neurons are damaged, and some patients experience headaches while others suffer from impaired mobility. Diagnostic tests usually pinpoint the affected area. There is no cure, and treatment usually consists of symptomatic relief and possibly physical therapy.
The white matter of the brain and spine is made up of a whitish fatty substance that coats bundles of nerve cells. If there is damage or deterioration of this insulating material, chemical and electrical transmissions cannot travel along the axon to the synapses between cells. Similar to an electrical wire losing its outer insulation, arcing or shorting can occur. In nerve cells, this action can cause inappropriate or non-existent signal transmission.
Rapidly changing sodium levels commonly cause osmotic demyelination. Patients diagnosed with hyponatremia, or low salt levels, are often given hypertonic solutions containing the electrolyte. When the infusion occurs too rapidly, the body does not have a chance to equalize the salt levels in the blood, extracellular and intracellular spaces. Researchers believe that hypernatremic solutions adversely affect myelin, causing it to deteriorate.
Doctors also see the condition in patients receiving treatment for hypernatremia. Reducing serum salt levels too rapidly causes cells to release sodium ions in an attempt to correct the imbalance. Cells dehydrate and shrink, possibly causing demyelination. Similarly, patients undergoing dialysis for end-stage renal disease may experience osmotic demyelination from electrolyte imbalances or blood gas changes. Other medical conditions that can contribute to the syndrome include liver failure, organ transplants, and long-term use of diuretics.
In the brain, osmotic demyelination can occur in the pons, basal ganglia, and thalamus. The areas around the ventricles are another location that is sometimes affected. Patients experiencing demyelination in these regions may experience nausea, vomiting, and confusion or loss of consciousness. If the condition occurs in the spine, patients experience parkinsonian-like tremors or coordination difficulties on both sides of the body. The limbs may also become flaccid and patients may have difficulty swallowing or speaking.
Doctors consider osmotic demyelination a medical emergency and do physical evaluations, blood tests, and imaging studies, which determine blood abnormalities and the site of demyelination. Patients can receive infusion fixes to prevent further damage to the myelin. In some cases, patients recover completely. In others, the damage is permanent. Depending on the location of the impairment, some patients improve with physical therapy, while others require lifelong assistance with daily activities.
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