A child locked-in due to iatrogenic osmotic demyelination syndrome


  • Indrajit Suresh Department of Gastroenterology and Hepatology, JSS University Hospital, Mysore, Karnataka
  • Meenakshi Katyal Department of Gastroenterology and Hepatology, JSS University Hospital, Mysore, Karnataka




Osmotic demyelination syndrome, Locked in syndrome, Hypertonic saline, Hyponatremia, Quadriparesis, Dysarthria


Iatrogenic Osmotic demyelination syndrome (ODS) may follow aggressive correction of hyponatremia with hypertonic saline. Locked-in syndrome (LIS), is an entity rarely encountered in ODS, and has been infrequently reported in children. LIS has variable outcomes, although associated with significant morbidity and a protracted course. The authors present a report of a 5 year old, developmentally normal female- who developed features of ODS, progressing to LIS in a matter of days. Recurrent seizures necessitated mechanical ventilation and the administration of propofol. Assessment of her mentation, ocular movements and phonation were done on a daily basis post- extubation. Early enteral feeds were started and rehabilitation was initiated involving the healthcare staff as well as the child’s parents. The outcome was fortunate in spite of the fact that the illness had a prolonged and difficult course. The patient made a full recovery, and did not suffer from any sequele after 3 months.


Martin RJ. Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes. J Neurol Neurosurg Psychiatr. 2004;75(Suppl 3):iii22-8.

Bauer G, Gerstenbrand F, Rumpl E. Varieties of the locked-in syndrome. J Neurol. 1979;221:77-91.

Plum F, Posner JB. The diagnosis of stupor and coma. 3rd ed. Philadelphia: F. A. Davis Co., 1983;363-4.

American Congress of Rehabilitation Medicine. Recommendations for use of uniform nomenclature pertinent to patients with severe alterations of consciousness. Arch Phys Med Rehabil. 1995;76:205-9.

Bruno MA, Schnakers C, Damas F. Locked-in syndrome in children: report of five cases and review of the literature. Pediatr Neurol. 2009;41(4):237-46.

Golden GS, Leeds N, Kremenitzer MW, Russman BS. The ‘‘locked-in’’ syndrome in children. J Pediatr. 1976;89:596-8.

Smith E, Delargy M. Locked-in syndrome. BMJ. 2005;330:406-9.

Walterfang M, Goh A, Mocellin R. Peduncular hallucinosis secondary to central pontine myelinolysis. Psychiatry and Clinical Neurosciences. 2012;66(7):618-21.

Ashrafian H, Davey P. Review of the causes of central pontine myelinosis: yet another apoptotic illness? European Journal of Neurology. 2001;8(2):103-9.

Suresh I, Deb P, Chandra BD, Jeevan HR. Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis mimicking dengue encephalitis in a child. Int J Res Med Sci. 2015;3:2481-4.

Love S. Demyelinating diseases. J Clin Pathol 2006;59:1151-9.

Karakaş HM, Erdem G, Yakinci C. Osmotic demyelination syndrome in a 40-day-old infant. Diagn Interv Radiol. 2007;13(3):121-4.

Miller GM, Baker HL Jr, Okazaki H, et al.Central pontine myelinolysis and its imitators: MR findings. Radiology 1988;168:795-802.

Menger H, Jörg J. Outcome of central pontine and extrapontine myelinolysis (n = 44). J Neurol. 1999;246(8):700-5.