{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T01:25:01Z","timestamp":1791854701230,"version":"4.3.4"},"reference-count":13,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,9,5]],"date-time":"2024-09-05T00:00:00Z","timestamp":1725494400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["NINDS #R01 NS39422"],"award-info":[{"award-number":["NINDS #R01 NS39422"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000780","name":"the European Commission","doi-asserted-by":"crossref","award":["ICT-2011- 287739"],"award-info":[{"award-number":["ICT-2011- 287739"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"name":"the Ministry of Economy and Competitiveness","award":["RTC-2015-3967-1"],"award-info":[{"award-number":["RTC-2015-3967-1"]}]},{"name":"the Spanish Health Research Fund","award":["FIS PI12\/01602"],"award-info":[{"award-number":["FIS PI12\/01602"]}]},{"name":"the Spanish Health Research Fund","award":["FIS PI16\/00451"],"award-info":[{"award-number":["FIS PI16\/00451"]}]},{"DOI":"10.13039\/501100004837","name":"Ministry of Science and Innovation","doi-asserted-by":"crossref","award":["TED2021-130174B-C33"],"award-info":[{"award-number":["TED2021-130174B-C33"]}],"id":[{"id":"10.13039\/501100004837","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Neurohospitalist"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Rapid correction of hyponatremia can result in osmotic demyelination syndrome (ODS). Sheehan\u2019s syndrome, a rare pituitary disorder caused by severe postpartum hemorrhage, is a potential cause of chronic hyponatremia. This case report describes a rare progression of extrapontine myelinolysis to central pontine myelinolysis, ultimately leading to ODS, following the correction of chronic hyponatremia associated with Sheehan\u2019s syndrome. Notably, this event occurred a decade after the initial postpartum hemorrhage due to placenta previa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Report<\/jats:title>\n                    <jats:p>A 40-year-old woman from rural West Bengal, India, presented in a comatose state after five years of progressively worsening symptoms, including fatigue, gastrointestinal disturbances, cold intolerance, hair loss, and severe apathy, which had been misdiagnosed as psychogenic and treated with selective serotonin reuptake inhibitors. Two days before her admission to our hospital, she was diagnosed with a lower respiratory tract infection, dehydration, and severe hyponatremia (118 mEq\/L) at a local private healthcare facility. Despite treatment with 3% sodium chloride and intravenous antibiotics, her condition deteriorated, prompting her transfer. At the time of hospitalization, the patient was diagnosed with chronic hyponatremia and hypopituitarism consistent with Sheehan\u2019s syndrome. This condition was attributed to a severe postpartum hemorrhage that occurred a decade prior, resulting from placenta previa. Initial MRI revealed extrapontine myelinolysis, and the correction of her \u201ccompensated\u201d hyponatremia was identified as the cause of her neurological decline. Follow-up MRIs at 7 and 14 weeks confirmed the development of cavitating ODS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case highlights several key points: First, even a relatively gradual correction of hyponatremia can precipitate ODS, especially in patients with chronic conditions like Sheehan\u2019s syndrome. Second, it underscores the importance of meticulous management of chronic hyponatremia to prevent severe neurological outcomes. Third, it illustrates the diagnostic challenges of differentiating Sheehan\u2019s syndrome from primary psychiatric disorders, particularly in low-resource settings where the syndrome remains prevalent. The case also emphasizes the need for awareness among healthcare providers about the potential for severe complications arising from even minor corrections in serum sodium levels in such patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19418744241279491","type":"journal-article","created":{"date-parts":[[2024,9,7]],"date-time":"2024-09-07T00:44:11Z","timestamp":1725669851000},"page":"188-194","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Cavitating Osmotic Demyelination Syndrome Following Correction of Chronic Hyponatremia in Sheehan\u2019s Syndrome: A Novel Case Report"],"prefix":"10.1177","volume":"15","author":[{"given":"Alamgir","family":"Shaikh","sequence":"first","affiliation":[{"name":"Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1766-4183","authenticated-orcid":false,"given":"Mois\u00e9s","family":"Le\u00f3n-Ruiz","sequence":"additional","affiliation":[{"name":"Section of Clinical Neurophysiology, Department of Neurology, University Hospital \u201cLa Paz\u201d, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8192-0807","authenticated-orcid":false,"given":"Ritwik","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Soren","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilwatosh","family":"Mukhopadhyay","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shyamal Kanti","family":"Pal","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1769-4809","authenticated-orcid":false,"given":"Juli\u00e1n","family":"Benito-Le\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital \u201c12 de Octubre\u201d, Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Hospital 12 de Octubre (i+12), Madrid, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain"},{"name":"Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,9,5]]},"reference":[{"key":"bibr1-19418744241279491","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12051714"},{"key":"bibr2-19418744241279491","first-page":"77","volume":"12","author":"Siddiqui FM","year":"2011","journal-title":"J 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