Osmotic Demyelination Syndrome Associated with Uremia and Elevated Serum Osmolality

Excerpt

A middle-aged man with no known past medical history presented to an outside facility with progressively worsened mental status 1 week after a detached retina repair from an eye injury. At the facility, he had a witnessed cardiac arrest. Return of spontaneous circulation was achieved after 5 min. Given a very swollen and proptotic eye on examination, there was high concern for sepsis from necrotizing fasciitis of the eye and possible meningoencephalitis. He was started on broad spectrum antibiotics and evaluated by an ophthalmologist. The intraocular pressure was normal, but there was concern for emphysema and cellulitis (Fig. 1a). Computed tomography angiogram of the head and neck demonstrated extensive foci of gas in the neck, skull base, bilateral orbits, and venous structures, along with bilateral orbital proptosis with subcutaneous emphysema and large air fluid levels within the right globe (Fig. 1b).

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