Osmotic Demyelination Syndrome In A Normonatremic Patient With Chronic Kidney Disease

Osmotic demyelination syndrome (ODS), also known as central pontine myelinolysis, is a neurological disorder characterised by myelin loss in the central pons and other parts of the brain, such as the basal ganglia, lateral geniculate bodies, external and internal capsules and cerebellum. ODS is a demyelinating disorder associated with rapid correction of hyponatraemia. Classically, this is associated with hyponatraemia, but it can also occur in the presence of normonatremia. Changes in osmolality are found to be responsible in the pathogenesis of the lesions. Rarely, pontine myelinosis with delirium was also described in normonatremic patients. We report the clinical and radiological findings of a normonatremic 45-year-old female patient with chronic kidney disease, who experienced central pontine myelinolysis. This report aims to show that pontine myelinolysis may also occur in normonatremic circumstances, and early, rapid management of the disorder is important to prevent permanent damage.