A child locked-in due to iatrogenic osmotic demyelination syndrome

Iatrogenic Osmotic demyelination syndrome (ODS) may follow aggressive correction of hyponatremia with hypertonic saline. Locked-in syndrome (LIS), is an entity rarely encountered in ODS, and has been infrequently reported in children. LIS has variable outcomes, although associated with significant morbidity and a protracted course. The authors present a report of a 5 year old, developmentally normal female- who developed features of ODS, progressing to LIS in a matter of days. Recurrent seizures necessitated mechanical ventilation and the administration of propofol. Assessment of her mentation, ocular movements and phonation were done on a daily basis post- extubation. Early enteral feeds were started and rehabilitation was initiated involving the healthcare staff as well as the child’s parents. The outcome was fortunate in spite of the fact that the illness had a prolonged and difficult course. The patient made a full recovery, and did not suffer from any sequele after 3 months.