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Case Report
 
Osmotic demyelination affecting extrapontine areas of brain
Uduman Ali Mohamed Yousuf1, Heng Siang Ting2, BM Yashodhara3, Shashikiran Umakanth4
1HOD, Department of Medicine, Melaka Manipal Medical College, Melaka, Malaysia.
2House Officer, Tuanku Ja'afar Hospital, Seremban, Malaysia.
3Department of Medicine, Melaka Manipal Medical College, Melaka, Malaysia.
4HOD, Department of Medicine, Melaka Manipal Medical College, Manipal, India.

doi:10.5348/ijcri-201591-CR-10552

Address correspondence to:
Dr. Yashodhara BM
Professor, Department of Medicine, Melaka Manipal Medical College
Melaka 75150
Malaysia
Fax: 006-28187977

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How to cite this article
Yousuf UAM, Ting HS, Yashodhara BM, Umakanth S. Osmotic demyelination affecting extrapontine areas of brain. Int J Case Rep Images 2015;6(9):564–569.


Abstract
Introduction: Inappropriate fluid management in sick patients has a rare potential consequence called osmotic demyelination syndrome (ODS); either central pontine myelinolysis (CPM) or extrapontine myelinolysis (EPM) or combination of both. As reported in the studies, the incidence of these varies from 0.05–5.7% as per the different autopsy studies. The clinical presentation is variable from "Locked in syndrome" to seizures, behavioral and personality changes.
Case Report: A 58-year-old ADL (activities of daily living) independent, apparently healthy, social and friendly female presented with aggressive behavior, excessive talking and disorientation after being treated for vomiting and diarrhea in a hospital. All these symptoms and events occurred after initial treatment for pneumonia. Her CT scans of brain were normal and had normal blood reports on thorough assessment.
Conclusion: Prompt evaluation with EEG and MRI scan clinched the diagnosis of osmotic demyelination syndrome (ODS). We report one such presentation in the patient who had complete recovery at one year of follow-up.

Keywords: Behavioral disturbance, Extrapontine area of brain, Osmotic demyelination, Sodium


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Author Contributions
Uduman Ali Mohamed Yousuf – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Heng Siang Ting – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Yashodhara BM – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Shashikiran Umakanth – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
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Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Uduman Ali Mohamed Yousuf et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.