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Osmotic demyelination syndrome
Other Resources UpToDate PubMed

Osmotic demyelination syndrome

Contributors: Carolyn Zyloney MD, Jamie Adams MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed


Osmotic demyelination syndrome (ODS), also called central pontine and extrapontine myelinolysis, is a condition caused by destruction of the myelin sheath surrounding nerves in the central nervous system. The damage is thought to be caused by rapid osmolar shifts in the central nervous system, leading to entry of water into brain cells and brain swelling, followed by volume loss from brain cells and cell death. It most commonly results from rapid correction of hyponatremia but can also be seen in patients with other electrolyte disturbances, malnutrition, severe burns, alcohol use disorder, renal failure, or liver disease. The pons is the part of the brain most commonly affected; however, other brain regions can also be involved.

Symptoms depend on the brain regions that are damaged but may include seizures, quadriparesis, hyperreflexia, pseudobulbar palsy, gaze paralysis, diplopia, dysphagia, dysarthria, tremor, ataxia, and altered mental status. There may be a bimodal presentation, with acute symptoms followed by several days of improvement and then subacute deterioration. Prognosis is variable and there is a risk of death or chronic disability.


G37.2 – Central pontine myelinolysis

6807001 – Central pontine myelinolysis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Brain stem stroke
  • Acute demyelinating encephalomyelitis
  • Multiple sclerosis
  • Neuromyelitis optica spectrum disorder
  • Limbic Encephalitis
  • Brain stem glioma
  • Wernicke-Korsakoff syndrome
  • Seizure / Status epilepticus
  • Spinal cord injury
  • Metabolic encephalopathy
  • Hyperammonemia

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:08/07/2018
Last Updated:04/03/2023
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Osmotic demyelination syndrome
A medical illustration showing key findings of Osmotic demyelination syndrome : Fatigue, Delirium, Dysarthria, Gait disturbance, Gaze abnormal, Mental status alteration, Quadriplegia, Dysphagia
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