Is It Structural or Metabolic? A Diagnostic Dilemma

Abstract

Osmotic demyelination syndrome (ODS), a disease affecting chronic alcoholic and malnourished
patients was described by Adams and colleagues in 1959. It is also known as pontine
myelinolysis. Pontine myelinolysis can be subdivided into central pontine myelinolysis (CPM)
and extrapontine myelinolysis (EPM) depending upon the level of demyelination, within the
pons or outside the pons, respectively. Rapid correction of hyponatremia contributes to the
pathogenesis of ODS. Whenever a chronic alcoholic and/or malnourished develops confusion,
quadriplegia, pseudobulbar palsy and pseudocoma (Locked-in-syndrome) over a period of
several days, a high index of suspicion for ODS must be held