Cytotoxic Lesions of the Corpus Callosum Preceding Osmotic Demyelination Syndrome in Hypernatremia and Hyperosmolar Hyperglycemic State: A Case Report

Osmotic demyelination syndrome (ODS) is a rare neurological disorder associated with osmotic imbalances. Traditionally, ODS has been known to occur following the rapid correction of hyponatremia; however, ODS has also been reported concerning hypernatremia and hyperglycemia. Cytotoxic lesions of the corpus callosum (CLOCC), identified using transient magnetic resonance imaging, can arise from various causes, including drugs, vascular diseases, infections, and metabolic disturbances such as electrolyte imbalances and dysglycemia. The simultaneous occurrence of ODS and CLOCC is extremely rare. Here, we report a case whereby a 57-year-old male initially developed CLOCC via severe hypernatremia and hyperosmolar hyperglycemic state (HHS) was also subsequently identified with ODS. Physicians should know CLOCC may be an early radiologic finding in ODS associated with severe hypernatremia and HHS. Therefore, proactive brain imaging should be considered in these patients to facilitate the early detection of neurological complications.