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Treatment response in osmotic demyelination syndrome presenting as severe parkinsonism, ptosis and gaze palsy
  1. Sanihah Abdul Halim1,
  2. Nur Aida Mohd Amin2
  1. 1Department of Medicine (Neurology), School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
  2. 2Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
  1. Correspondence to Dr Sanihah Abdul Halim, sanihahabdhalim{at}


Osmotic demyelination syndrome commonly affects the pons and infrequently involves the extrapontine region. We report a patient with severe hyponatraemia who developed osmotic demyelination syndrome as a consequence of rapid sodium correction. The condition manifested as acute severe parkinsonism, bilateral ptosis and gaze impairment. MRI revealed typical features of central pontine and extrapontine myelinolysis. The patient improved gradually after treatment with a combination of levodopa, intravenous immunoglobulin and dexamethasone. However, it is important to emphasise that the improvement of neurological symptoms is not necessarily causal with these experimental therapies.

  • brain stem / Cerebellum
  • fluid electrolyte and acid-base disturbances
  • unwanted effects / adverse reactions
  • parkinson’s disease

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  • Contributors SAH wrote and edited the manuscript. NAMA wrote, involved in acquisition of the patient’s data and investigation results.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.