Treatment response in osmotic demyelination syndrome presenting as severe parkinsonism, ptosis and gaze palsy

Hyponatremia and extrapontine myelinolysis in a patient with COVID-19: A case report

Until we have strong evidence to the contrary, symptomatic hyponatremia should be treated with extra caution in COVID-19 co-infection patients as the latter could be another risk factor for the development of extrapontine myelinolysis.

Dramatic Response to Pramipexole in Delayed-Onset Parkinsonism from Osmotic Demyelinating Syndrome

Background:

Delayed parkinsonism and dystonia are recognized phenomena in osmotic demyelinating syndrome (ODS). Dopamine receptor agonists and levodopa have been reported to benefit select patients.

Case report:

We report a patient with ODS with severe pseudobulbar deficits, parkinsonism and dystonia, poorly responsive to levodopa, who experienced a remarkable improvement with pramipexole.

Discussion:

A marked response to pramipexole with lack of response to levodopa suggests a pre-synaptic source for his deficits coupled with injuries to non-nigral compensatory structures.

Highlights:

This case highlights a dramatic response of osmotic demyelination-induced parkinsonism/dystonia to pramipexole. A lack of response to levodopa suggests deficits in the pre-synaptic nigral as well as non-nigral compensatory structures.