Progressive Injury in Iatrogenic Central Pontine Myelinolysis: The Impact of Delayed Diagnosis and Late Wallerian Degeneration.

A patient-authored longitudinal case report of severe iatrogenic osmotic demyelination syndrome (ODS), with neurological onset during hospitalisation in November 2023, initially subtle MRI findings and delayed radiological recognition of pontine injury.Recovery was uneven. Marked neurological deterioration through February 2024 was followed by slow improvement in some motor functions, while cognitive deterioration continued through October 2024, alongside persistent visual symptoms and substantial weight loss. Follow-up MRI on 17 October 2024 identified Wallerian degeneration, consistent with secondary axonal degeneration following the established pontine injury. This finding is examined in relation to the persistent neurological deficits and the prolonged clinical course.The report examines diagnostic delay, electrolyte and osmotic management, and delayed access to rehabilitation. Following discharge without rehabilitation guidance, the patient independently initiated physiotherapy, speech therapy and swallowing rehabilitation in May 2026, with reported functional benefit.Late functional recovery included the return of complex analytical and professional writing skills through sustained daily relearning, activity pacing and rest, despite documented neuropsychological deficits. These gains coexist with persistent structural pontine injury and residual neurological impairment. Ongoing care includes serum sodium monitoring every other day.The account highlights the importance of timely diagnosis, appropriate electrolyte monitoring, continued assessment of persistent or worsening symptoms, and timely access to rehabilitation.