To systematically characterize the clinical and radiological features of osmotic demyelination syndrome (ODS) associated with glucose disturbances.

ODS, which includes central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM), results from demyelination following rapid alterations in serum osmolality. Although classically linked to rapid correction of hyponatremia, an increasing number of reports describe ODS secondary to glucose abnormalities or their correction, as glucose is also an osmotically active molecule. However, the clinical presentation, imaging patterns, and outcomes of glucose-related ODS have not been comprehensively summarized.

A systematic search of PubMed, Web of Science, Scopus, and Embase was conducted through August 1, 2025. Statistical analyses were performed using SPSS. Comparative analyses between CPM, EPM, and combined lesion groups were conducted using Chi-square testing with Monte Carlo simulation (10,000 samples). Quality assessment was assessed using the JBI checklist. The protocol was registered in PROSPERO (CRD420251146640).

ODS related to glucose disturbances, though uncommon, should be considered in patients experiencing rapid glucose shifts who develop acute neurological symptoms. Early recognition is essential to optimize diagnosis and management.