Personality Trait Dimensions and Depressive Symptoms Among Medical Students: Sequential Mediation Through Psychological Capital and Perceived Stress.

Demyelinating lesions involving the cervicomedullary junction and dorsal columns resulting in demyelination can stem from various causes, including inflammatory and metabolic []. Inflammatory demyelinating diseases, such as multiple sclerosis (MS), transverse myelitis, and neuromyelitis optica spectrum disorder (NMOSD), are the most common differentials when magnetic resonance imaging (MRI) enhancements are present with lesion evolution []. Metabolic myelopathies, such as subacute combined degeneration, may also produce this finding of dorsal column-predominant signal change but without radiographic enhancement []. Osmotic demyelination syndrome (ODS) is a noninflammatory demyelinating disorder that is most commonly associated with the rapid correction of chronic hyponatremia []. Despite the most common manifestation of ODS being central pontine myelinolysis, extrapontine involvement is also well recognized and may impact structures such as the basal ganglia, thalami, and mammillary bodies []. However, spinal cord involvement is rarely reported and remains poorly described in the literature []. It is important to differentiate osmotic injury from inflammatory myelopathy because treatment differs and health outcomes can be affected. Significant electrolyte imbalances are more suggestive of ODS. However, enhanced lesions, new lesions on subsequent MRIs, and a worsening of symptoms tend to suggest an autoimmune process.