JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
REFERENCES
findings from Mayo Clinic patients with CPM were correlated with their clinical outcomes at discharge and last follow-up. The study concluded that the extent of lesion abnormality found on MRI was not associated with the clinical outcome of the patient, emphasizing the importance of avoiding “a premature pessimistic prognostication based on severe radiologic abnormalities.” 19 In another study it was shown that a favorable outcome for ODS patients was more likely in patients who had a higher Glascow Coma Scale score at hospital entry, less severe hyponatremia, and an absence of concurrent hypokalemia at the time of diagnosis. 18 Findings of both these studies are valuable to physicians in evaluating a prognosis and counseling patients and caregivers about disease outcomes.
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CONCLUSION
Osmotic Demyelinating Syndrome historically arises as a serious complication of rapid correction of hyponatremia, yet its manifestations seem to be influenced by a multifactorial process. Theories on current models of the pathogenesis of ODS have elucidated the various metabolic pathways involved in its development helping to explain how various conditions independent of changes in serum electrolytes, including the patient’s nutritional status, and predisposing illnesses like diabetes, renal failure and post liver transplantation may predispose certain patient populations to developing ODS. In current practice, the diagnosis of ODS is definitively made using MRI, yet the lesions identified on brain MRI may not always correlate with the patient’s clinical presentation. Patients may span a spectrum of clinical manifestations involving extrapontine and/or pontine symptoms or may even be clinically asymptomatic despite lesions identified in those regions on brain MRI. The extent of imaging findings also depends on the time course of ODS, as development of MRI changes have in some cases been shown to be delayed in relation to the onset of clinical symptoms. Management of ODS begins with prevention, but once ODS has developed, the current treatment focuses on supportive care with the significant intent of minimizing secondary complications of neurological impairment, including aspiration pneumonia, ascending urinary tract infections, venous thrombosis, and pulmonary embolism. Studies on the role of steroid administration and the use of minocycline and other anti-apoptotic drugs have shown benefit in animal models, though to date there are no clinical trials in humans proven to support this practice. Despite improved overall outcomes of ODS thanks to primary prevention and early diagnosis, defining prognostic factors are still being determined. We hope that this review will further endorse and aid in the proper diagnosis of ODS and its suitable management through the understanding of clinical and imaging correlations and outcomes, and the comorbid factors that may predispose the development of ODS in certain patient populations.
92 J La State Med Soc VOL 169 JULY/AUGUST 2017
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