Treatment response in osmotic demyelination syndrome presenting as severe parkinsonism, ptosis and gaze palsy

Abstract

Osmotic demyelination syndrome commonly affects the pons and infrequently involves the extrapontine region. We report a patient with severe hyponatraemia who developed osmotic demyelination syndrome as a consequence of rapid sodium correction. The condition manifested as acute severe parkinsonism, bilateral ptosis and gaze impairment. MRI revealed typical features of central pontine and extrapontine myelinolysis. The patient improved gradually after treatment with a combination of levodopa, intravenous immunoglobulin and dexamethasone. However, it is important to emphasise that the improvement of neurological symptoms is not necessarily causal with these experimental therapies.

Hyponatremia and extrapontine myelinolysis in a patient with COVID‐19: A case report

“…However, all these options need to be further studied to clarify their role in ODS management. Some patients with predominant dystonia and muscle rigidity showed a considerable response to levodopa 4 . Our patient received a low dose of carbidopa/levodopa.…”

“…Some patients with predominant dystonia and muscle rigidity showed a considerable response to levodopa. 4 Our patient received a low dose of carbidopa/levodopa. We appreciated an improvement in his clinical condition over more than four months of follow‐up.…”

“…A few case reports suggest successful use of high‐dose levodopa for the treatment of EPM in patients who present with Parkinson's‐like symptoms. 4 …”

“…Isolated extrapontine myelinolysis (EPM), a form of osmotic demyelination, is a rare yet the most feared complication of hyponatremia correction treatment that can develop due to rapid correction of hyponatremia. A few case reports suggest successful use of high‐dose levodopa for the treatment of EPM in patients who present with Parkinson's‐like symptoms 4 …”

Acute parkinsonism as an unexpected consequence of pituitary adenoma resection

“…Acute parkinsonism as a consequence of EPM may respond well to dopamine supply and immunotherapy. [11,21,22] Besides, previous studies have revealed that the volume of T2 signal change on MRI is not directly correlate with clinical outcome. [22]…”