Osmotic Demyelination Syndrome

摘要

A31-year-old man with a past medical history of alcohol abuse presented with sudden-onset ataxia, dysarthria, dysphagia, and bilateral resting hand tremors that had started approximately 1 week prior. The symptoms had started with bilateral hand tremors and had progressed such that he was unable to type and work at his computer. Shortly thereafter, the patient noticed difficulty speaking and walking. He stated that he was unable to articulate coherently while having telephone conversations. He noted difficulty with balance while walking and a sensation of weakness in both lower extremities. These symptoms had progressed over a week, at which point the patient presented to the emergency department (ED). History. The patient denied illicit drug use, and he did not take any medications. His past surgical history and family history were unremarkable. He reported that he had drunk alcohol daily for the past 10 years, and that he had stopped cold turkey about 4 weeks prior. Further investigation revealed that the patient had presented to the ED 3 weeks prior for an episode of loss of consciousness with associated nausea, vomiting, and bilateral hand tremors. At that time, the patient had reportedly attempted to quit drinking and had not consumed alcohol for 2 to 3 days before arrival. Findings of a head computed tomography (CT) scan performed at that visit were unremarkable.