Brain Myelinolysis Following Hypernatremia in Rats

Soupart, Alain; Penninckx, Raymond; Namias, Bernard; Stenuit, Alain; Périer, O; Decaux, Guy

doi:10.1097/00005072-199601000-00011

Cited by 72 publications

(31 citation statements)

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“…Lateral pontine and extrapontine myelinolysis can be associated with hypernatremia and hyperosmolality 20 . Experimental data shown that high and sustained levels of hypernatremia could induce brain myelinolysis in rats 21 . In both hypo and hypernatremic states, the significant event may be an increase in serum sodium or serum osmolality with sufficient rapidity and magnitude.…”

Section: Discussionmentioning

confidence: 99%

Pontine and extrapontine osmotic myelinolysis after the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with fluoxetine: case report

Twardowschy

Bertolucci

Gracia

2007

Arq. Neuro-Psiquiatr.

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-Osmotic demyelination syndrome (ODS) may be precipitated by aggressive correction of a hypo or hyper-osmolar states. We describe the case of a 53-year-old woman that was started on fluoxetine 20 mg/day for depression and nine days later was found to have fluoxetine-induced syndrome of inappropriate secretion of antidiuretic hormone. After hyponatremia correction the mental status of the patient gradually improved, but subsequently she had intermittent difficulty in speaking, naming objects, memory deficits and psychomotor slowness. Magnetic resonance revealed bilateral symmetric hyperintense lesions in the basal ganglia, temporal lobe and hippocampal formation compatible with ODS. These symptoms gradually resolved and she was discharged home without any deficits. Two months later, a new image showed lesion in pons and the other lesions had disappeared. Fluoxetine therapy had never been related with a complication like that.KEY WORDS: central pontine and extrapontine myelinolysis, osmotic demyelination syndrome, hyponatremia, fluoxetine.Mielinólise osmótica pontina e extrapontina após a síndrome da secreção inapropriada de hormônio antidiurético associada com fluoxetina: relato de caso RESUMO -A síndrome de desmielinização osmótica (SDO) pode ser precipitada pela correção agressiva de um estado hiper ou hipoosmolar. Nós descrevemos o caso de mulher de 53 anos que havia iniciado o uso de fluoxetina 20 mg/dia para depressão e que nove dias depois foi diagnosticada como tendo síndrome da secreção inapropriada de hormônio antidiurético induzida por fluoxetina. Depois da correção da hiponatremia o estado mental da paciente gradualmente melhorou, mas subsequentemente ela apresentou dificuldade intermitente para fala e para nomear objetos, déficits de memória recente e lentidão psicomotora. Ressonância magnética revelou lesões hiperintensas bilaterais e simétricas na região dos gânglios da base, lobo temporal e hipocampo compatíveis com SDO. Estes sintomas gradualmente se resolveram e a paciente foi de alta sem qualquer déficit. Dois meses mais tarde uma nova imagem cerebral mostrou lesão na ponte e ausência das lesões antigas. Até onde sabemos a terapia com fluoxetina nunca foi relacionada a uma complicação tardia como esta. PALAVRAS-CHAVE: mielinólise central pontina e extrapontina, síndrome de desmielinização osmótica, hiponatremia, fluoxetina.

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Section: Discussionmentioning

confidence: 99%

Pontine and extrapontine osmotic myelinolysis after the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with fluoxetine: case report

Twardowschy

Bertolucci

Gracia

2007

Arq. Neuro-Psiquiatr.

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“…This rapid increase in the plasma sodium concentration during a short period induces osmotic injury in vascular endothelial cells and is considered to be the major cause of central pontine myelinolysis [13]. It was demonstrated in rats that a rapid increase in the plasma sodium concentration (39 mEq/l or more in 6-12 hr) induces demyelinating encephalomyelitis in the thalamus, brain stem, tegmentum, and hippocampus [20]. Histological evaluation of the brain stem was not performed in this study.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Efficacy of Desmopressin Acetate for Diabetes Insipidus after Hypophysectomy in the Dog.

et al. 2003

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ABSTRACT. The prophylactic efficacy of desmopressin acetate (DDAVP) on diabetes insipidus (DI) after hypophysectomy was investigated in the dog. In the control group, hypernatremia with a plasma level of 155 mEq/l or higher persisted for 12 hr from the 4th to the 16th hour after hypophysectomy, and symptoms of DI developed within five days after surgery. In the DDAVP treatment group, these changes were not observed, showing that administration of DDAVP (4 µg, instillation, twice daily) effectively prevented hypernatremia that develops immediately after surgery and DI-like symptoms that persists for about one week after surgery. KEY WORDS: canine, desmopressin acetate, hypophysectomy.J. Vet. Med. Sci. 65(1): 17-22, 2003 As modern imaging procedures such as magnetic resonance imaging and computed tomography have become widely used in the field of veterinary medicine, the precision of antemortem diagnosis of pituitary tumor has increased in recent years [3,7]. In veterinary neurosurgery, transsphenoidal hypophysectomy is recognized as useful for pituitary adenoma of the anterior and intermediate lobes accompanied by Cushing's syndrome in dogs and cats, and these surgical procedures and results of such surgery in clinical cases have been reported [6,7,9,12]. However, total resection of pituitary tissue, which plays a central role in endocrine function, induces endocrinological abnormalities after surgery such as diabetes insipidus (DI), hypoadrenocorticism, and hypothyroidism, requiring careful postoperative management mainly by hormone supplementation therapy. Among these pituitary hormone deficiencies, DI due to antidiuretic hormone (ADH) deficiency is an important clinical problem encountered soon after surgery because it causes the loss of a large volume of hypotonic fluid into urine, hypernatremia, and an acute decrease in the circulating blood volume, which may induce hypovolemic shock [18]. In the field of veterinary medicine, a V2-receptor selective agonist, desmopressin acetate (generic name: 1-deamino-8-D-argininevasopressin acetate trihydrate, DDAVP), is used to treat spontaneous central DI [1,21]. The use of DDAVP for management of postoperative DI after hypophysectomy in the dog with pituitary tumor was reported [7]. In that report, however, the dogs had endocrinological abnormalities before surgery caused by pituitary tumor, and surgery was followed by hormone supplement therapy using glucocorticoids, mineralcorticoids, and thyroid hormones. Therefore, it was difficult to evaluate the efficacy of DDAVP alone for postoperative DI after hypophysectomy. In this study, we evaluated fluid and electrolyte abnormalites due to antidiuretic hormone deficiency after surgery and investigated the prophylactic efficacy of DDAVP on DI in the dog after hypophysectomy. MATERIALS AND METHODSExperimental animals: Clinically healthy beagles, seven males and three females (mean age 3.6 years, mean body weight 12.5 kg), were used. No abnormality was observed in physical examination, complete blood count, biochemistry, a...

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“…During rapid correction of hypernatraemia, cerebral lesions are generally related to constitution of brain oedema, as previously discussed [9]. In addition, experimental and clinical studies have documented central pontine and extrapontine myelinolysis and other less speci®c lesions characterised by diuse brain hypodensities on CT scans [2,11,34].…”

Section: Cerebral Lesions During Hypernatraemiamentioning

confidence: 93%

“…Acute myelinolysis is characterised by selective demyelinisating lesions with sparing of neurons and axonal segments and generally occurs in locations where myelinated tissue is surrounded by grey matter [33,34]. Among these, the basis of the pontis is a frequent location and lesions are referred as central pontine myelinolysis.…”

Section: Cerebral Lesions During Hypernatraemiamentioning

confidence: 99%

Cell volume regulation and transport mechanisms across the blood-brain barrier: implications for the management of hypernatraemic states

Petris¹,

Luchetti

Emma³

2001

European Journal of Pediatrics

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Brain Myelinolysis Following Hypernatremia in Rats

Cited by 72 publications

References 0 publications

Pontine and extrapontine osmotic myelinolysis after the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with fluoxetine: case report

Pontine and extrapontine osmotic myelinolysis after the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with fluoxetine: case report

Prophylactic Efficacy of Desmopressin Acetate for Diabetes Insipidus after Hypophysectomy in the Dog.

Cell volume regulation and transport mechanisms across the blood-brain barrier: implications for the management of hypernatraemic states

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