Osmotic Demyelination Syndrome Occurs Early in The Course of Hyperosmolar Hyperglycemic State.
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 3
Abstract
Osmotic demyelination syndrome (ODS) is a life-threatening demyelinating syndrome. The association of ODS with hyperosmolar hyperglycaemic state (HHS) has been seldom reported. The aim of this study was to show that Osmotic Demyelination Syndrome occurs early in the course of Hyperosmolar Hyperglycaemic state and the pathophysiological mechanisms involved in ODS secondary to HHS. A 45 year old female with poorly controlled Type2 Diabetes Mellitus came to the emergency room due to loss of consciousness. She had a Glasgow Coma Scale of 3/15 and muscle power was 0/5 in all the limbs and plantar were flexor bilaterally. Blood Glucose levels were 600mg%. Plasma and urinary ketones were negetive. Arterial Blood Gas analysis showed pH 7.31. HbA1C was 14.1%, Serum Calcium 7.9 mg/dL. Serum creatinine was 4.5 mg/dL. NCCT Brain came to be Normal at the time of admission. Supportive therapy was started subsequently and she was put on Insulin infusion and blood glucose was closely monitored. She regained consciousness but she was disoriented and had irrelevant talks. Muscle power came normal. One week after admission MRI Brain was taken which showed focal areas of T2 Hypersensitivities in pons and subcortical white matter of bilateral parietal lobes suggestive of osmotic demyelination syndrome.In conclusion, the association of ODS with HHS is extremely rare. The exact mechanism by which HHS produces ODS still needs to be elucidated, but we favor a rapid hypertonic insult as the most probable mechanism.
Authors and Affiliations
Jacob Raja A. S. , Neilasakou Linyu, Bhupen Rabi Das, Kamalom Mossang, Salam Ranabir Singh, Lallan Prasad, Santa Naorem
Keywords
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