Pontine and extra-pontine osmotic demyelination syndrome: Case report

Osmotic demyelination syndrome is a rare disease, clinically presented as a global reduction in strength, tetraparesis, variations in the level of consciousness, and its content, and comatose status, associated with rapid variances in serum sodium levels (whether hyponatremia or hypernatremia). The neuroimaging findings are mainly in the pontine region, but currently the number of reports of extrapontine involvement has increased, typically with lesions in the topography of the thalamus, cerebellum, midbrain (substantia nigra), corpus callosum and hypothalamus. We display a rare case of pontine and extra-pontine involvement, even after the sodium replacement protocols of the current guidelines.