Fitts Whitney, Vogel Andre C, Mateen Farrah J
Children's Hospital of Philadelphia (WF), PA; Department of Neurology (WF, ACV, FJM), Massachusetts General Hospital, Boston; Harvard Medical School (WF, FJM), Boston, MA.
Neurol Clin Pract. 2021 Aug;11(4):304-310. doi: 10.1212/CPJ.0000000000000932.
To describe the long-term outcomes of osmotic demyelination syndrome (ODS) in an updated cohort.
We performed a retrospective medical records review of cases of ODS at the Massachusetts General and Brigham and Women's Hospitals using International Classification of Diseases-9th edition codes and a text-based search for , , and (1999-2018). Cases were individually selected based on patients having neuroimaging and symptoms consistent with ODS and no other potentially explanatory etiology. Modified Rankin scale (mRS) scores were extracted at prehospitalization, hospital discharge, 6 months post discharge, and the most recently available clinical visit.
We identified 45 cases of ODS (mean age 48.4 years, range 0.07-75 years; 58% female patients). Common comorbidities included liver disease (27%, n = 12), alcoholism (44%, n = 20), and kidney failure (20%, n = 9). Twenty-nine percent of patients had a rapid correction of hyponatremia. Twenty-nine percent had other electrolyte abnormalities. Only 59% (24/41) of patients with complete electrolyte data had abnormalities that could explain their ODS. At the 6-month follow-up, 16% of the patients were dead and 60% of patients had minimal-to-no disability (mRS 0-2).
ODS has a diverse range of clinical presentations. Not all patients have electrolyte abnormalities. The prognosis is generally favorable, although 1 in 6 patients had died at 6 months, likely because of underlying disease states.
在一个更新的队列中描述渗透性脱髓鞘综合征（ODS）的长期预后。
我们使用国际疾病分类第9版编码，对麻省总医院以及布莱根妇女医院的ODS病例进行了回顾性病历审查，并通过基于文本的搜索查找（1999 - 2018年）。根据患者神经影像学和症状符合ODS且无其他潜在解释病因的情况进行个案选择。提取患者院前、出院时、出院后6个月以及最近一次临床就诊时的改良Rankin量表（mRS）评分。
我们确定了45例ODS患者（平均年龄48.4岁，范围0.07 - 75岁；58%为女性患者）。常见合并症包括肝病（27%，n = 12）、酗酒（44%，n = 20）和肾衰竭（20%，n = 9）。29%的患者低钠血症得到快速纠正。29%的患者有其他电解质异常。在有完整电解质数据的患者中，只有59%（24/41）的患者存在可解释其ODS的异常。在6个月随访时，16%的患者死亡，60%的患者残疾程度轻微至无残疾（mRS 0 - 2）。
ODS有多种临床表现。并非所有患者都有电解质异常。尽管6名患者中有1名在6个月时死亡，可能是由于基础疾病状态，但总体预后良好。
