Is It Structural or Metabolic? A Diagnostic Dilemma

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