Central Pontine Myelinolysis
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
A 35-year-old man presented with acute alcoholic hepatitis and encephalopathy. He was hyponatremic, with a sodium level of 119 mmol per liter. Over the next 5 days his clinical condition improved with supportive treatment, which included lactulose and intravenous vitamins and the careful administration of normal saline for hypovolemia. His serum sodium level gradually increased by approximately 3 mmol per liter per day until reaching 135 mmol per liter. On the sixth day, his level of consciousness declined to a score of 6 on the Glasgow Coma Scale. Findings on computed tomography of the head, performed without the administration of contrast material, were unremarkable. Over the next 2 days, neurologic examination revealed tetraparesis with normal tone. The quadriceps and biceps reflexes were brisk, and the plantar reflex was upward in both feet, but other reflexes were normal. MRI of the brain revealed a central area of high T2 (Panel A, arrows) and low T1 (Panel B, arrow) signaling in the pons, with restricted diffusion (Panel C, arrows). These findings are typical in patients with central pontine myelinolysis, or osmotic demyelination syndrome, which typically occurs in response to overly rapid correction of hyponatremia (usually a correction of more than 9 mmol per liter per 24 hours)...

http://bit.ly/2sTjs5d
Dr. M●●●p P●●●l and 1 others like this
Like
Comment
Share