r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2024-29-5-4-12r-n-j-617Research ArticleОБЗОРЫREVIEWSОсмотический демиелинизирующий синдромOsmotic demyelination syndromehttps://orcid.org/0000-0001-6824-4114РамазановГ. Р.RamazanovG. R.

Moscow

https://orcid.org/0000-0002-8490-1417КовалеваЭ. А.KovalevaE. A.

Moscow

kovalevaea@sklif.mos.ruhttps://orcid.org/0009-0000-2256-0779АкчуринаК. Р.AkchurinaK. R.

Moscow

https://orcid.org/0009-0004-9758-1661БыковаМ. Е.BykovaM. E.

Moscow

Научно-исследовательский институт скорой помощи им. Н.В. СклифосовскогоРоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationРоссийский университет медициныРоссияRussian University of MedicineRussian Federation202406012025295412Copyright © Рамазанов Г.Р., Ковалева Э.А., Акчурина К.Р., Быкова М.Е., 20252025Рамазанов Г.Р., Ковалева Э.А., Акчурина К.Р., Быкова М.Е.Ramazanov G.R., Kovaleva E.A., Akchurina K.R., Bykova M.E.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/617Введение

Введение. Осмотический демиелинизирующий синдром (ОДС) — жизнеугрожающее состояние, вызванное водно-электролитными нарушениями, как правило, связанными с быстрой коррекцией гипонатриемии, проявляющееся остро возникающей демиелинизацией головного мозга. Средний возраст пациентов с ОДС варьирует от 30 до 50 лет. Частота неблагоприятного исхода (летальность/полная зависимость от посторонней помощи) варьирует от 33 до 55%. Цель работы. Систематизация данных об этиологии, патофизиологии, клинических проявлениях, диагностике и лечении ОДС.

Материал и методы

Материал и методы. Поиск литературы выполнен в электронных поисковых системах Scopus, eLibrary, PubMed по ключевым словам: осмотический демиелинизирующий синдром, центральный понтинный миелинолиз, экстрапонтинный миелинолиз. Для анализа были отобраны научные статьи, опубликованные в период с 1959 по 2024 г.

Результаты

Результаты. Основная причина развития ОДС — водно-электролитные нарушения, возникающие вторично на фоне тяжелой соматической патологии. Клинические проявления ОДС носят интермиттирующий характер. Характерно клиническое улучшение после быстрой коррекции осмолярности с последующим развитием через 3–5 дней клинической картины острого миелинолиза. В настоящее время специфической терапии ОДС нет. Тем не менее, ранняя диагностика данного заболевания является крайне важной вследствие высокой частоты развития расстройств сознания и дыхания, которые требуют проведения искусственной вентиляции легких. Полиморфизм клинических симптомов, а также невысокая осведомленность врачей, затрудняют диагностику и своевременное начало терапии ОДС. Оптимальным методом нейровизуализации у пациентов с ОДС является МРТ в режимах DWI, T2 и Т2 FLAIR. Скорость коррекции гипонатриемии не более чем на 10 ммоль/л в первые 24 ч и не выше чем на 8 ммоль/л каждые последующие сутки — основной способ профилактики развития ОДС.

Introduction

Introduction. Osmotic demyelinating syndrome(ODS) is a life-threatening condition caused by water and electrolyte disturbances, usually associated with rapid correction of hyponatremia, manifested by acute demyelination of the brain. The average age of development of patients with ODS varies from 30 to 50 years. The incidence of unfavorable outcome (mortality/complete dependence on outside help) varies from 33 to 55%.

Objective

Objective. Systematization of data on the etiology, pathophysiology, clinical manifestations, diagnosis and treatment of osmotic demyelinating syndrome.

Material and methods

Material and methods. The literature search was performed in the electronic search engines Scopus, eLibrary, PubMed using the keywords: osmotic demyelinating syndrome, central pontine myelinolysis, extrapontine myelinolysis. Scientific articles published between 1959 and 2024 were selected for analysis.

Results

Results. The main reason for the development of ODS is water and electrolyte disturbances that occur secondary to severe somatic pathology. Clinical manifestations of ODS are intermittent. Сlinical improvement is typical after rapid correction of osmolarity, followed by the development after 3–5 days of a clinical picture of acute myelinolysis. Currently, there is no specific therapy for ODS. However, early diagnosis of this disease is extremely important due to the high incidence of disorders of consciousness and breathing that require artificial ventilation. The polymorphism of clinical symptoms, as well as the low awareness of doctors, complicate the diagnosis and timely initiation of therapy for ODS. The optimal method of neuroimaging in patients with ODS is MRI in DWI, T2 and T2 FLAIR modes. The rate of correction of hyponatremia by no more than 10 mmol/l in the first 24 hours and no higher than 8 mmol/l every subsequent day is the main way to prevent the development of ODS.

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The authors declare that there are no conflicts of interest present.