1887
Volume 2022, Issue 4
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Hypernatremia (serum sodium>160 meq/L) present with diverse neurological manifestations, ranging from flaccid paralysis to impaired cognition, encephalopathy, and even deep coma. Osmotic demyelination refers to changes in brain cells because of an acute change in plasma osmolality. It is further divided into two types, i.e., central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM). Patients with EPM, besides spasticity, may also present with other movement disorders such as catatonia, parkinsonism, and dystonia. We present a case of a postpartum woman bought to the emergency department by her relatives in an unconscious state. In view of poor sensorium (Glasgow coma scale < 7), she was intubated and received mechanical ventilatory support. On admission, computed tomography ofthebrain was normal, and the patient was transferred to the intensive care unit (ICU) for further management. The preliminary work-up in the ICU showed hypernatremia (serum sodium of 182 mEq/L) with hyper-osmolality (359 mOsm/kgHO). She was managed as per the ICU protocol for hypernatremia. During her ICU stay, her sensorium improved, but she developed flaccid paralysis and was quadriplegic. Thus, a tracheostomy was performed, and she was weaned from the ventilator. After ventilator weaning, she was transferred to the ward for further rehabilitation. During rehabilitation, the patient was able to sit and takefoodorally.To date, only a few cases are reported in postpartum women with acute severe hypernatremia caused by high-grade fever and loss of body fluids leading to extra-pontine demyelination and flaccid paralysis. This case highlightsthat prompt recognition and appropriate intervention can improve the outcomes in these patients.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2022.45
2022-10-13
2024-03-29
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2022/4/qmj.2022.45.html?itemId=/content/journals/10.5339/qmj.2022.45&mimeType=html&fmt=ahah

References

  1. Samuels MA, Seifter JL. Encephalopathies caused by electrolyte disorders. Semin Neurol. 2011; 31:135138.
    [Google Scholar]
  2. Martin RJ. Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes. J Neurol Neurosurg Psychiatry. 2004; 75:Suppl 3:iii228.
    [Google Scholar]
  3. Lambeck J, Hieber M, Dreßing A, Niesen WD. Central pontine myelinosis and osmotic demyelination syndrome. Dtsch Arztebl Int. 2019; 116:600606.
    [Google Scholar]
  4. Kamath M, Manjunath S. Idiopathic central pontine and extrapontine myelinolysis in a child. J Pediatr Neurosci. 2019; 14:9799.
    [Google Scholar]
  5. Han MJ, Kim DH, Kim YH, Yang IM, Park JH, Hong MK. A case of osmotic demyelination presenting with severe hypernatremia. Electrolyte Blood Press. 2015; 13:3036, doi:10.5049/EBP.2015.13.1.30.
    [Google Scholar]
  6. Ismail FY, Szóllics A, Szólics M, Nagelkerke N, Ljubisavljevic M. Clinical semiology and neuroradiologic correlates of acute hypernatremic osmotic challenge in adults: a literature review. AJNR Am J Neuroradiol. 2013; 34:222532.
    [Google Scholar]
  7. Khan SU, Saeed MS, Misbah D, Idrees M, Abdullah A. Central pontine myelinolysis in pregnancy: A case of rare occurrence. Cureus. 2021; 13:e20281.
    [Google Scholar]
  8. Schrier RW. Systemic arterial vasodilation, vasopressin, and vasopressinase in pregnancy. J Am Soc Nephrol. 2010; 21:570572.
    [Google Scholar]
  9. Naik KR, Saroja AO. Seasonal postpartum hypernatremic encephalopathy with osmotic extrapontine myelinolysis and rhabdomyolysis. J Neurol Sci. 2010; 291:511.
    [Google Scholar]
  10. Bekiesiñska-Figatowska M, Bulski T, Rózyczka I, Furmanek M, Walecki J. MR imaging of seven presumed cases of central pontine and extrapontine myelinolysis. Acta Neurobiol Exp (Wars). 2001; 61:141144.
    [Google Scholar]
  11. Graff-Radford J, Fugate JE, Kaufmann TJ, Mandrekar JN, Rabinstein AA. Clinical and radiologic correlations of central pontine myelinolysis syndrome. Mayo Clin Proc. 2011; 86:10631067.
    [Google Scholar]
  12. Yamada H, Takano K, Ayuzawa N, Seki G, Fujita T. Relowering of serum na for osmotic demyelinating syndrome. Case Rep Neurol Med. 2012; 2012:704639.
    [Google Scholar]
  13. Kuruvilla A, Joseph S. “Wine Glass” appearance: a unique MRI observation in a case of primary lateral sclerosis. Neurol India. 2002; 50:306309.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/qmj.2022.45
Loading
/content/journals/10.5339/qmj.2022.45
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error