Osmotic Demyelination Syndrome in End-Stage Renal Disease After Recent Hemodialysis: MRI of the Brain

Abstract

In patients who develop osmotic demyelination syndrome after hemodialysis, the lesions may involve the pons or the pons and extrapontine sites. Most lesions that were followed up resolved rapidly and almost completely, favoring transient edema rather than demyelination. Blood chemistries suggested underlying changes in osmolality, particularly as a result of urea shift from the extracellular fluid.

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).…”

Reversible Clinical and Magnetic Resonance Imaging of Central Pontine Myelinolysis Following Surgery for Craniopharyngioma: Serial Magnetic Resonance Imaging Studies -Case Report-

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Similar symmetrical lesions also occur in extrapontine locations, including the subcortex, thalamus, putamen, and globus pallidus, a condition termed extrapontine myelinolysis. 9) CPM has been generally observed in patients with a history of alcoholism and malnutrition, 1) but has also been found in patients with anorexia nervosa, orthotopic liver transplantation, diabetes, burns, sepsis, end-stage renal disease, and other diseases.…”

“…9) CPM has been generally observed in patients with a history of alcoholism and malnutrition, 1) but has also been found in patients with anorexia nervosa, orthotopic liver transplantation, diabetes, burns, sepsis, end-stage renal disease, and other diseases. 3,4,6,7,15,18,20) Early diagnosis of CPM is often difficult, and some cases are discovered only at autopsy. 7,13) The pathogenesis remains unclear, but CPM may be associated with rapid correction or overcorrection of hyponatremia.…”

Diffuse Leukoencephalopathy Associated with Dialysis Disequilibrium Syndrome

“…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). PRES is a reversible encephalopathy (especially in the posterior white matter) caused by the breakdown of the bloodbrain barrier (BBB) due to acute hypertension or vascular endothelial dysfunction (9,10).…”