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Those eyes don’t lie: a case of osmotic demyelination syndrome in a patient with hepatic encephalopathy

  • Caleb J. Murphy , Peter L. Cathcart and Andrew P.J. Olson EMAIL logo
Published/Copyright: April 26, 2016
Diagnosis
From the journal Diagnosis Volume 3 Issue 2

Abstract

Osmotic demyelination syndrome (ODS), previously known as central pontine myelinolysis, is a rare neurological condition characterized by demyelination of the pons or extrapontine areas including the midbrain, thalamus, basal nuclei, and cerebellum, resulting in upper motor neuron dysfunction and pseudobulbar palsy. We report a case of a 45-year-old woman with a history of alcohol dependence and end stage liver disease complicated by hepatic encephalopathy who developed symptoms suspicious of recurrent hepatic encephalopathy and experienced a generalized seizure during an inpatient stay. After 10 days of treatment with no improvement, it was noted that the patient had locked-in syndrome and that her sodium levels had rapidly risen 2 days prior. This led to a clinical suspicion of ODS, which was confirmed on T2-weighted MRI and subsequently on autopsy. In this clinical vignette, we review the clinical presentation, prognosis, and diagnostic considerations of ODS.

Keywords: central pontine myelinolysis; diagnostic error; physical examination
Corresponding author: Andrew P.J. Olson, MD, Division of General Internal Medicine, Departments of Medicine and Pediatrics, University of Minnesota Medical School, 420 Delaware Street, SE, MMC 741, Minneapolis, MN 55455, USA, Phone: +612-624-8984

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2016-1-26
Accepted: 2016-3-1
Published Online: 2016-4-26
Published in Print: 2016-6-1

©2016 by De Gruyter

Articles in the same Issue

  1. Frontmatter
  2. Opinion Paper
  3. Healthcare is a giant with feet of clay
  4. Original Articles
  5. Diagnosis is a team sport – partnering with allied health professionals to reduce diagnostic errors
  6. An investigation into method of diagnosis in clinicopathologic conferences (CPCs)
  7. Primary care pediatricians’ interest in diagnostic error reduction
  8. Spurious elevation of serum potassium concentration measured in samples with thrombocytosis
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  10. Case Reports
  11. Those eyes don’t lie: a case of osmotic demyelination syndrome in a patient with hepatic encephalopathy
  12. CA-125: What does that lab really mean?
  13. Letter to the Editor
  14. Assessment of reticulated platelets with automated hemocytometers: are we measuring the same thing?
  15. Congress Abstracts
  16. Diagnostic Error in Medicine 1st European Conference June 30–July 1, 2016
https://doi.org/10.1515/dx-2016-0004
Keywords for this article
central pontine myelinolysis; diagnostic error; physical examination

Articles in the same Issue

  1. Frontmatter
  2. Opinion Paper
  3. Healthcare is a giant with feet of clay
  4. Original Articles
  5. Diagnosis is a team sport – partnering with allied health professionals to reduce diagnostic errors
  6. An investigation into method of diagnosis in clinicopathologic conferences (CPCs)
  7. Primary care pediatricians’ interest in diagnostic error reduction
  8. Spurious elevation of serum potassium concentration measured in samples with thrombocytosis
  9. Mobile phone exposure influences some erythrocytes parameters in vitro. A novel source of preanalytical variability?
  10. Case Reports
  11. Those eyes don’t lie: a case of osmotic demyelination syndrome in a patient with hepatic encephalopathy
  12. CA-125: What does that lab really mean?
  13. Letter to the Editor
  14. Assessment of reticulated platelets with automated hemocytometers: are we measuring the same thing?
  15. Congress Abstracts
  16. Diagnostic Error in Medicine 1st European Conference June 30–July 1, 2016
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