The woman returned to the ED 10 days later with a two-day history of slurred speech. Findings on head CT suggested a basilar tip aneurysm. Subsequent MRI with and without contrast as well as intracranial MR angiography confirmed the presence of a basilar tip aneurysm but also revealed findings consistent with osmotic demyelination syndrome (formerly known as central pontine myelinolysis).
The woman’s initial neurologic examination revealed dysarthria, right upper-extremity weakness without spasticity, and confusion interspersed with lucid intervals. Her presentation and diagnostic imaging findings were felt to be consistent with osmotic demyelination syndrome. This diagnosis was later confirmed in a neurologic consultation.
The patient’s neurologic examination revealed continued mild dysarthria, difficulty standing, and the need for support when she attempted to walk. She also had mild oral and pharyngeal dysphagia and deficits in language and writing.
The plaintiff charged that the defendant raised the plaintiff’s sodium level more rapidly than was appropriate, resulting in neurologically devastating osmotic demyelination. The plaintiff claimed that normal saline should have been administered and that the serum sodium should have been checked every four hours during the first 24 hours of treatment. The plaintiff also alleged negligence in the continuation of normal saline after a serum sodium level of 112 mEq/L was achieved. The defendants, however, maintained that the treatment provided was appropriate.
A $550,000 settlement was reached.