Síndrome de desmielinización osmótica. Reporte de caso

Abstract

Background: Osmotic demyelination syndrome is a severe and infrequent neurological disorder, with a global prevalence of 0.3% to 1.1%. It is characterized by demyelinating lesions in the pontine tracts of the brainstem, predominantly manifesting in individuals with severe electrolyte imbalances, with the improper correction of hyponatremia being a common iatrogenic cause. Clinically, it can manifest with symptoms such as tetraparesis, dysarthria, and dysphagia, potentially resulting in fatal complications or leaving significant neurological sequelae. Case Presentation: A 66-year-old man who presented with dysarthria, dysphagia, and weakness in the lower extremities, symptoms that developed after the rapid sodium correction at a private clinic due to severe hyponatremia. Following hospitalization, the diagnosis of central pontine myelinolysis was confirmed by brain MRI. During his hospital stay, the patient developed quadriparesis, generalized spasticity, and an altered level of consciousness, with a high risk of bronchoaspiration. As part of the therapeutic management, supportive measures were implemented, including the placement of a gastrostomy tube for persistent dysphagia, with a slight improvement. The patient was discharged with an uncertain short-term prognosis. Conclusion: Osmotic demyelination syndrome is a frequently underdiagnosed condition with a poor prognosis. The need for careful and standardized management in the correction of electrolyte imbalances, especially in patients with hyponatremia, is highlighted, given the high morbidity and mortality associated with this pathology.