Ibtissam El Bqaq, Yahya El Harras, Ittimade Nassar, Kaoutar Imrani
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 3
Issue: 7
Date of Publication: 2026/07/31
Osmotic demyelination syndrome, encompassing central pontine and extrapontine myelinolysis, is a rare but potentially devastating neurological complication increasingly recognised in patients with end-stage renal disease undergoing haemodialysis, in whom abrupt osmotic shifts during dialysis sessions can trigger the disease even without overt correction of hyponatraemia. We report the case of a 32-year-old woman with end-stage renal disease on maintenance haemodialysis, with no other notable medical history, who was admitted for refractory convulsive status epilepticus. Initial brain CT was unremarkable. Brain MRI performed as part of the aetiological work-up demonstrated a centropontine and mesencephalic lesion, hypointense on T1-weighted images, hyperintense on T2 and FLAIR sequences, with restricted diffusion and no contrast enhancement, consistent with central pontine myelinolysis. In addition, bifrontal and left occipital cortico-subcortical T2/FLAIR hyperintensities without diffusion restriction or enhancement were identified, without mass effect, raising the possibility of a concomitant posterior reversible encephalopathy-type process. Vascular imaging was normal. This case illustrates the importance of considering osmotic demyelination syndrome in haemodialysis patients presenting with unexplained refractory seizures, even without a classical history of hyponatraemia correction, and highlights the complementary diagnostic value of multimodal MRI in this setting.
Central pontine myelinolysis, Osmotic demyelination syndrome, Haemodialysis, End-stage renal disease, Status epilepticus
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