[Severe hyponatraemia and central pontine myelinolysis: be careful with other factors!]. / Hyponatrémie sévère et myélinolyse centropontine : attention aux cofacteurs !

Central pontine myelinolysis covers very different clinical aspects, ranging from discrete tremor to quadriplegia. Rapid correction of hyponatraemia is a well-known risk factor, particularly in chronic alcohol abusers. We describe the case of a 46-year-old chronic alcoholic, suffering from denutrition. He developed a quadriplegia and a facial diplegia two weeks after a slow correction of a chronic hyponatraemia associated with hypokalaemia. Central pontine myelinolysis was formally diagnosed by MRI findings. In our case, the correction of hyponatraemia is not the only causal agent of this syndrome; hypokalaemia and denutrition seem to be predisposing factors too. For these reasons, glial cells are more vulnerable to osmotic variations. Despite of severe initial symptoms, the evolution was favourable with a quasi complete recovery.

Traumatic pulmonary hernia: surgical versus conservative management.

The therapeutic management of lung herniation, an uncommon complication of severe blunt chest trauma, remains controversial. We report here on two cases of traumatic lung herniation with different, yet successful, methods of therapeutic management according to the particular anatomic types. Because of the threat of tension pneumothorax, incarceration, or strangulation of the lung parenchyma in mechanically ventilated patients, surgical reduction of intercostal pulmonary hernias with narrow necks is usually recommended. In contrast, supraclavicular pulmonary hernias secondary to clavicle-sternal dislocation may be treated conservatively with serial clinical and thoracic imaging follow-up including chest computed tomographic scan. In this anatomical type of lung herniation, favorable spontaneous evolution is frequently observed, presumably because of the presence of a larger thoracic wall defect together with the absence of associated perforating bone trauma. The efficacy of the therapeutic approach proposed herein remains to be confirmed by further experience.