Subject(s)
Craniopharyngioma/surgery , Myelinolysis, Central Pontine/surgery , Pituitary Neoplasms/surgery , Postoperative Complications/therapy , Child , Craniopharyngioma/pathology , Humans , Male , Myelinolysis, Central Pontine/diagnosis , Myelinolysis, Central Pontine/pathology , Pituitary Neoplasms/pathology , Treatment OutcomeABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Myelinolysis, Central Pontine/drug therapy , Myelinolysis, Central Pontine/surgery , Myelinolysis, Central Pontine/complications , Colectomy/methods , Hemofiltration/instrumentation , Hemofiltration/methods , Hemofiltration , Diuretics/therapeutic use , Hyponatremia/complications , Liver Transplantation/methods , Colonic Neoplasms/drug therapy , Colonic Neoplasms/surgery , Shock, Septic/complications , Shock, Septic/drug therapy , Hyperglycemia/complications , Hypernatremia/complications , Hypernatremia/diagnosisABSTRACT
Osmotic demyelination syndrome (ODS) is a well-known disorder caused by rapid correction of serum sodium. Many conditions including hormonal abnormality are associated with this syndrome. The authors describe two cases of preoperative sellar region tumor associated with hypopituitarism and secondary adrenal insufficiency. These two patients had hyponatremia. Neurological manifestations in both of them were generalized dystonia. Magnetic resonance imaging (MRI) revealed a characteristic extrapontine myelinolysis (EPM). The first case was a 35-year-old man with craniopharyngioma who developed generalized dystonia after rapid correction of hyponatremia. The second case was a 24-year-old man with gonadotroph pituitary adenoma who developed generalized dystonia, dysarthria, and dysphagia in the course of hyponatremia. Hormonal changes will cause fluctuation in hyponatremia and correction of hyponatremia, even if the recommended rate may be hazardous and will promote ODS. Patients with sellar region tumors are at risk of developing ODS and correction of hyponatremia in these cases should be closely monitored.
Subject(s)
Craniopharyngioma/diagnosis , Myelinolysis, Central Pontine/diagnosis , Pituitary Neoplasms/diagnosis , Adrenal Insufficiency/complications , Adult , Craniopharyngioma/complications , Diagnosis, Differential , Fatal Outcome , Humans , Hyponatremia/complications , Hypopituitarism/complications , Magnetic Resonance Imaging , Male , Myelinolysis, Central Pontine/etiology , Myelinolysis, Central Pontine/surgery , Pituitary Neoplasms/complications , Tomography, X-Ray ComputedABSTRACT
A 62-year-old woman, after a resection and ileostomy for multiple perforations of the terminal ileum and prolonged postoperative parenteral nutrition, developed thiamine deficiency with clinical and magnetic resonance imaging features of Wernicke's disease. Later on the patient developed central pontine myelinolysis. For this condition, a pathogenetic role of a transient hypophosphatemia was suggested by both laboratory data and course of the disease.
Subject(s)
Hypophosphatemia/complications , Myelinolysis, Central Pontine/etiology , Wernicke Encephalopathy/etiology , Electrolytes/blood , Female , Humans , Hypophosphatemia/surgery , Ileostomy/methods , Magnetic Resonance Imaging , Middle Aged , Myelinolysis, Central Pontine/pathology , Myelinolysis, Central Pontine/surgery , Thiamine Deficiency , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Wernicke Encephalopathy/pathology , Wernicke Encephalopathy/surgeryABSTRACT
La mielinolisis central pontina es un síndrome conocido desde hace más de 4 décadas y primariamente descrito en pacientes alcohólicos, que consiste en una desmielinización de la sustancia blanca cerebral. Su mecanismo fisiopatológico se basa en los cambios osmóticos producidos en esta estructura al corregirse de forma brusca una hiponatremia preexistente. El paciente que se somete a un trasplante hepático es, en la mayoría de las ocasiones, un cirrótico previo y en muchos casos de origen alcohólico. La hiponatremia en este grupo es la regla; es de origen multifactorial y está fundamentalmente en relación con la terapia que se les aplica para el control de la ascitis. Debemos extremar nuestros cuidados en la corrección de esta hiponatremia en el período perioperatorio del trasplante y detectar de forma temprana las alteraciones de conciencia en el postoperatorio inmediato, que deben alertarnos del desarrollo de este síndrome (AU)
Subject(s)
Adult , Female , Humans , Hyponatremia/complications , Hyponatremia/diagnosis , Hyponatremia/therapy , Hemofiltration/methods , Liver Transplantation/methods , Myelinolysis, Central Pontine/complications , Myelinolysis, Central Pontine/diagnosis , Myelinolysis, Central Pontine/surgery , Osmotic Pressure , Ascites/complications , Ascites/diagnosis , Liver Cirrhosis/complications , Liver Cirrhosis/diagnosis , Hyponatremia/complications , Hyponatremia/diagnosisABSTRACT
Tha case of a 55 year old man who presented with severe global headache 8 hours after having been drinking heavily, and who over a two hour period developed deep coma and flaccid paralysis of all four extremities is reported. A CT scan of the brain was normal; however, on Magnetic Resonance Imaging (MRI) extensive hyperintense areas in the brain stem, mainly in the pons, were easily identified. Based upon the clinical and MRI findings a diagnosis of Central Pontine Myelinolysis was made. Following several months of supportive therapy the patient partially recovered and was able to leave the hospital.