Osmotic demyelination syndrome due to rapid fluctuations in serum sodium - a case report
Abstract
Demyelination of the neural structures
can occur due to rapid correction of
chronic hyponatremia, and the diagnosis
can now be made by radiological demonstration
of hyperintense signals on T2
weighted MRI sequences. This is a case
report of a 13 year old boy with a craniopharyngioma
who underwent a transcranial
radical excision of the tumour. Postoperatively
he developed diabetes insipidus
with a wide fluctuation in the serum
sodium levels despite management
with intravenous fluids and pitressin analogues.
He developed spastic paresis of
all 4 limbs with preservation of only vertical
eye movements, suggestive of a
locked in syndrome. MRI brain showed
hyperintense signals within the brainstem
and the basal ganglia with no mass effect.
A diagnosis of osmotic demyelination
was made, and the patient gradually
recovered with supportive care over a
period of 3 months.
Full Text:
PDFReferences
Kleinschmidt BK, Norenberg MD:
Rapid Correction of hyponatremia
causes demyelination: Relation to central
pontine myelinolysis - Science.
Adams RA, Victor M, Mancall EL.
Central pontine myelinolysis: a hitherto
undescribed disease occuring in alcoholics
and malnourished patients. Arch
Neurol Psychiatry 1959; 81:154-72
Karp BI, Laureno R. Central pontine
and extrapontine myelinolysis after correction
of hyponatremia. The Neurologist
; 255-66
Sterns RH, Thomas DJ, Herndon
RM: Brain dehydration and neurologic
deterioration after rapid correction of
hyponatremia - Kidney Int. 1989;35
(1):69-75
Ruzek KA, Campeau NG, Miller GM:
Early diagnosis of central pontine myelinolysis
with diffusion weighted imaging.
AJNR Am J Neuroradiol 25(2):210-
Radford GJ, Fugate JE, Kauffmann
TJ: Clinical and radiologic correlations
of central pontine myelinolysis syndrome.
Mayo Clin Proc. 2011;86
(11):1063-7.
Dervisoglu E, Yegenaga I, Anik Y,
Sengul E, Turgut T. et al: Diffusion
Magnetic Resonance Imaging May Provide
Prognostic Information
in Osmotic Demyelination Syndrome: A
case report. Acta Radiol. 2006;47
(2):208-12
Cheng JC, Zikos D, Skopicki HA, et al.
Long-term neurologic outcome in psychogenic
water drinkers with severe symptomatic
hyponatremia: the effect of rapid correction.
Am J Med1990;88:561-6
Sterns RH. The management of symptomatic
hyponatremia. Semin Nephrol
;10:503-14
Oh MS, Kim HJ, Carroll HJ: Recommendations
for treatment of symptomatic hyponatremia.
Nephron 1995;70:143-50
Berl T. Treating hyponatremia: damned if
we do and damned if we don't. Kidney Int
;37:1006-18
Gill G, Huda B, Boyd A et al: Characteristics
and mortality of severe hyponatremia- a
hosptical based study. Clin Endocrinol (Oxf).
;65(2):246-9
Chawla A, Sterns RH, Nigwekar SU, Cappuccio
JD: Mortality and serum sodium: do
patients die from or with hyponatremia? Clin J
Am Soc Nephrol 2011;6(5):960-5
Loh JA, Verbalis JG: Diabetes insipidus as
a complication after pituitary surgery.Nat Clin
Pract Endocrinol Metab 2007; 3(6):489-494.
Gankam KF, Soupart A, Pochet R et al :
Re-induction of hyponatremia after rapid overcorrection
of hyponatremia reduces mortality
in rats. Kidney Int 2009: 76(6) : 614-21 Epub
Finsterer J, Engelmayer E, Trnka E et al :
Immunoglubulins are effective in pontine myelinolysis.
Clin Neuropharmacol 2000. 23: 110-
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
An Initiative of The Tamil Nadu Dr MGR Medical University