Osmotic Demyelination Syndrome: All You Need To Know

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Osmotic demyelination syndrome (ODS) is a dysfunction of the brain. It happens due to the destruction of a layer called myelin that covers the nerve cells in the middle of the brainstem. A common person does not know a lot about osmotic demyelination syndrome hence we have gathered all the necessary information in this one piece.

Keep reading to learn everything about the osmotic demyelination syndrome!

What Is Osmotic Demyelination Syndrome?

Before discussing what osmotic demyelination syndrome is, let’s learn about demyelination.


Myelin is a layer, or an insulating layer that is found around the nerves in the brain and the spinal cord. Demyelination is a generic pathological work that describes the loss of normal myelin around axons in our brain or the nervous system. In simpler words, it is the absence of myelin as the word suggests. 

Osmotic Demyelination Syndrome:

Osmotic demyelination syndrome is a situation where demyelination is seen of osmotic changes usually with the increasing correction of hyponatremia. It is basically a brain dysfunction. The harm is believed to be brought about by fast osmolar shifts in the nervous system, prompting passage of water into synapses and causing the brain to swell, trailed by volume misfortune from synapses and cell death.

Who Is More Likely To Get ODS?

Osmotic demyelination syndrome is more commonly found in the following cases:

  1. People having electrolyte disturbances
  2. People who are malnutritioned
  3. People who have (or any history of) severe burns 
  4. People who have alcohol use disorder
  5. People who have experienced renal failure
  6. People who have liver disease

Osmotic Demyelination Syndrome: Epidemiology

Previously recognized in 1959 by Adams et al, osmotic demyelination was found in a population of chronic alcoholics and hence, alcohol use disorder one very common cause of osmotic demyelination syndrome. 

First seen in 1959, it has been growing rapidly since then and is also found in other patient groups especially in people who have electrolyte disturbance:

  1. Chronic alcoholics
  2. Transplant recipients
  3. Chronically debilitated patients

What Are The Symptoms of ODS?

Symptoms of osmotic demyelination syndrome usually depend on the brain region that has been damaged.

This may include:

  1. Seizures
  2. Quadriparesis
  3. Hyperreflexia
  4. Pseudbulbar palsy
  5. Gaze paralysis
  6. Diplopia
  7. Dysphagia
  8. Tremor
  9. Ataxia
  10. Altered mental status

Osmotic Demyelination Syndrome: Pathology

The exact mechanism still being unidentified, oligodendroglial cells are said to be associated with osmotic stresses that lead to cell deaths. If we look back when it was first recognized and to date, the following are by what osmotic demyelination syndrome is characterized:

  1. Intramyelinic splitting
  2. Vacuolation
  3. Myelin sheath rupture

Causes of Osmotic Demyelination Syndrome:

When one has osmotic demyelination syndrome, the myelin sheath covering the nerve cells is destroyed and as a result of the destruction, signals from one nerve to another are disturbed and not transmitted properly. It affects different areas of the brain, however, the brainstem is mainly affected.

Amongst the many causes of osmotic demyelination syndrome, the most important one is the changes in the body’s sodium level. When someone is under treatment for low blood sodium also known as hyponatremia, they are most likely to get osmotic demyelination syndrome because they are sensitive and sodium is replaced too fastly. 

However, osmotic demyelination syndrome does not occur on its own. It usually is a result of a complication treatment for other medical problems. Osmotic demyelination syndrome risks include the following:

  1. Any liver disease
  2. Any alcohol usage history
  3. Any cause of malnutrition due to sickness
  4. Radiation treatment of the brain
  5. Morning sickness due to pregnancy including nausea and vomiting

ODS Clinical Representation

Clinically osmotic demyelination syndrome presents in a biphasic design. The main stage is typically inferable not to the demyelination but instead to the instigating electrolyte anomaly, with patients being intensely encephalopathic. Following quick inversion of this irregularity, the patient briefly improves prior to progressing onto the exemplary osmotic demyelination condition highlights 2 after 3 days. When pontine association is unmistakable, clinical highlights comprise of:

  1. Coma
  2. Death
  3. Pseudobulbar palsy
  4. Spastic quadriparesis
  5. Differences in levels of consciousness

Diagnosis of ODS

Always visit a doctor in case of any medical condition. 

Your doctor will most likely run a few blood tests to check and measure your sodium levels along with an MRI (medical resonance imaging) of your head (brain) to see if any damage to your brain stem. Moreover, they can also ask you to rake a brainstem auditory evoked response test by attaching electrodes to your head and ears.

Differential Diagnosis

Differential diagnosis for osmotic demyelination syndrome include the following:

  1. brain stem metastasis: mostly gets better
  2. Local vessels displacement in case of adjacent cisterns
  3. Demyelination (that includes multiple sclerosis)
  4. Pontine neoplasm (that includes astrocytomas)
  5. Infraction from basilar perforators

What Is The Treatment?

Osmotic demyelination syndrome is treatable. If you have any of the above-mentioned symptoms, you should visit a doctor as soon as possible. Treatment can vary from person to person but the following are the treatments that can be done:

  1. Related fluids and medications to regular sodium levels in the body.
  2. Physical therapy for improving balance and range of motion.


In some cases, patients completely recover. However, the survival rate for six month is only 5 percent to 10 percent.

Research Reference

Here we will be talking about research that was conducted on the osmotic demyelination syndrome. 

Summary Of The Research

According to the research, patients who have osmotic demyelination syndrome do not always make full recovery. The research reports a case of osmotic demyelination syndrome auxiliary to overcorrection of serious hyponatremia with pathognomonic clinical and radiologic signs making a total neurological recuperation. 

One main point of the research here is to show that, with good treatment and long-term care, recovery is possible in the patients.

Click here to see the full version of this research on osmotic demyelination syndrome.

Common FAQS

  1. When Does Osmotic Demyelination Syndrome Occur?

Osmotic Demyelination Syndrome normally starts 1-5 days after rectification of serum sodium level. The condition is ordinarily irreversible and devastating.

  1. Is Osmotic Demyelination Syndrome Reversible?

The symptoms are mostly irreversible. However, partial symptoms can be reversible.

  1. What Happens If Sodium Is Corrected Too Quickly?

New research and proof show that when patients with hyponatremia are brought to the hospital, their fretful treatment groups frequently correct sodium levels excessively fast, expanding the danger for hazardous medical health hazards. Too fast correction of sodium can cause osmotic demyelination syndrome.

  1. Is Osmotic Demyelination Syndrome Common?

There are no such exact measures or evidence of the authenticity of osmotic demyelination syndrome, however, according to research, the prevalence rate of osmotic demyelination syndrome is 0.25 percent to 0.5 percent. 

Bottom Line

Osmotic demyelination syndrome is a medical condition where demyelination is seen as osmotic changes for the most part with the expanding amendment of hyponatremia.

It is essentially a brain dysfunction. The damage is accepted to be achieved by quick osmolar shifts in the sensory system, inciting entry of water into neural connections and making the brain swell, followed by volume setback from neurotransmitters and cell demise.

Osmotic Demyelination Syndrome is not reversible however, there are a few treatments available.

We recommend you visit a doctor for any further medical prescriptions. The doctor will recommend some tests to get to know your body and the severity of osmotic demyelination syndrome. Your treatment will be based on your test results.

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