Central pontine myelinolysis during pregnancy: Pathogenesis, diagnosis and management

Abstract

Central pontine myelinolysis (CPM) is a rare condition usually caused by rapid sodium correction in hyponatraemia after a severe neurological syndrome. Only few cases have been reported during pregnancy, most of which were reported in patients with hyperemesis. We describe the successful management of the first case of twin pregnancy in a patient who presented with CPM after treatment for premature labour and then review the literature on CPM in pregnancy (aetiology, diagnosis and management). Our patient required emergency delivery to achieve electrolyte and fluid balance. At six months, the twins remained asymptomatic and the mother had minor sequelae. The aetiology is not clear, and there is no evidence regarding the optimal treatment or prognosis of CPM. In our patient, desmopressin-contaminated atosiban showed a certain probability in the Karch-Lasagne algorithm of a causality relationship between hyponatraemia and the drug. To our knowledge, this is the first case of myelinolysis reported in a twin pregnancy possibly related to desmopressin-contaminated atosiban.

Rare Complication of Hyperemesis Gravidarum - Central Pontine Myelinolysis, A Case Report

“…No optimal treatment is known for myelinolysis [3,5]. Prognosis is uncertain and ranges from recovery after long periods of neurological deficits to death due to worsening of neurological damage [3]. The case we reported recovered spontaneously with supportive care and did not have any neurological sequelae and delivered at term without any complications.…”

“…Cerebral magnetic resonance imaging (MRI) will show T1-weighted hypointense and T2-weighted hyperintense areas in the central pons and other extrapontine regions as described in our case. No optimal treatment is known for myelinolysis [3,5]. Prognosis is uncertain and ranges from recovery after long periods of neurological deficits to death due to worsening of neurological damage [3].…”

“…Myelinolysis can occur in extra-pontine sites as well. It is often associated with osmotic stress [3]. During pregnancy, CPM is most commonly seen in patients with hyperemesis gravidarum, in whom there is rapid fluctuation in blood osmolality due to hyponatraemia and its rapid correction.…”

Mielinolisis central pontina como complicación de hiperemesis gravidica

“…La mielinolisis central pontina, o síndrome de desmielinización osmótica, se asocia con una corrección rápida del sodio en la hiponatremia, con síntomas que aparecen entre el segundo y sexto día del diagnóstico de las alteraciones electrolíticas. Se caracteriza por destrucción de la mielina a nivel pontino, aunque puede afectar otras regiones extrapontinas (1) .…”

A case of osmotic demyelination syndrome detected after cesarean delivery with the administration of magnesium sulfate for threatened preterm labor

“…Magnesium sulfate (Mg) is a commonly used tocolytic agent that induces complications such as muscle weakness. The pregnancy-associated osmotic demyelination syndrome (ODS) is rare, although it can be caused by some situations, leading to muscle weakness and quadriplegia [ 1 – 3 ]. In addition, transient neurologic symptoms and cauda equina syndrome following spinal anesthesia for cesarean section could result in gait disorder.…”