Central Pontine Myelinolysis in a Previously Healthy 4-Year-Old Child With Acute Rotavirus Gastroenteritis

Gregorio, Laura; Sutton, Curtis L.; Lee, Deborah A.

doi:10.1542/peds.99.5.738

Cited by 27 publications

(17 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1 Most often changes occur supratentorially but occasionally the posterior fossa (pons-cerebellum) is primarily involved. [2][3][4] This is what occurred in our patient. The supratentorial findings were not as profound as the infratentorial, pontine, and parapontine findings (Fig.…”

Section: Discussionsupporting

confidence: 77%

Acute Ataxia in an Infant

Swischuk¹

2005

Pediatric Emergency Care

View full text Add to dashboard Cite

CASEThis 18-month-old boy, previously healthy, except for recurrent bouts of otitis media, suddenly, one afternoon, started to stagger and weave while walking. Very quickly, this became worse and he then developed a left facial droop with some drooling. In addition, the mother noticed that he could not focus on her with his eyes and then she became quite concerned. All of this happened within a few hours.She took the infant to her local emergency room where the patient was evaluated. At that institution, a CT study of the brain without contrast was interpreted as being normal. The white blood cell count was 12,400 with 43% neutrophils, 45% lymphocytes, 1% monocytes, and 1% eosinophils. A urinalysis was negative and an attempted spinal tap revealed a bloody tap. Thereafter, the patient was referred to our emergency room (ER). In our ER, the previously noted neurologic deficits were substantiated and no new ones were detected. The patient did indeed stumble while walking, and for certain, had a left facial droop. At the same time, the patient was relatively coherent and would respond to commands, questions, and so forth. Repeat laboratory investigation substantiated the results from the incoming hospital.Prior to this episode, and as previously noted, the patient was healthy except for repeated bouts of otitis media. However, the patient fell at dayschool the day before and hit his right cheek. The patient also had another fall at home on a carpeted floor. None of these episodes were reflective of major trauma, and thus could be dismissed as significant factors.On arrival to our ER, the patient's heart rate was 135 per minute and regular, the blood pressure 110/62, the temperature 36.58C, and the respiratory rate was 38 and regular. Physical examination was normal except for those findings referable to the central nervous system. These findings were exactly the same as those elicited in the patient's home emergency room.A repeat spinal tap revealed a glucose level of 65 mg%, a total protein level of 61 mg%, a white blood cell count of 165 with a differential of 8% segmented neutrophils, 29% lymphocytes, 6 atypical lymphocytes, and 56% monocytes. Various clinical consultations were obtained, blood was sent off for evaluation for any abnormal aminoacidurias or other metabolic abnormalities, and an MR study of the brain was obtained (Fig. 1). What do you think the diagnosis might be in this patient? Radiology in the ED

show abstract

Section: Discussionsupporting

confidence: 77%

Acute Ataxia in an Infant

Swischuk¹

2005

Pediatric Emergency Care

View full text Add to dashboard Cite

show abstract

“…We found 54 cases (63% female, median age 45 years, interquartile range 45-58 years) of osmotic demyelination syndrome published since 1997: 45 individual case reports and three case series including a total of nine patients (72,129,130,131,132,133,134,135,136,137,138,139,140,141,142,143,144,145,146,147,148,149,150,151,152,153,154,155,156,157,158,159,160,161,162,163,164,165,166,167,168,169,170,171,172,173,174,175). In 96% (52/54), the diagnosis of osmotic demyelination syndrome was based on magnetic...…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Spasovski

Vanholder

Allolio

et al. 2014

European Journal of Endocrinology

633

671

View full text Add to dashboard Cite

Hyponatraemia, defined as a serum sodium concentration !135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution-and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association -European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

show abstract

“…Children, as well as adults, tend to have predisposing illnesses and associated electrolyte disturbances as were noted inour patient. EPM and CPM have also been reported in association with liver transplantation, acute myelogenous leukemia, craniopharyngioma, dialysis, adrenal insufficiency, folate deficiency, and cytomegalovirus hepatitis [10,[13][14][15][16][17][18][19][20][21][22][23][24][25]. Associated electrolyte abnormalities have included hyponatremia as well as hypernatremia, and in rare cases in children as in adults, CPM/EPM has occurred in the absence of alterations in serum sodium values.…”

Section: Discussionmentioning

confidence: 99%

Osmotic Demyelination and Hypertonic Dehydration in a 9-Year-Old Girl: Changes in Cerebrospinal Fluid Myelin Basic Protein

Shah

Tobias

2006

J Intensive Care Med

View full text Add to dashboard Cite

A 9-year-old girl was admitted for the treatment of hyper-natremic dehydration. Her history was significant for psychogenic polydipsia, hyponatremia, and a renal concentrating defect. She presented with a 2-day history of altered mental status, ataxia, lethargy, fever, nausea, vomiting, and diarrhea. Meningitis was ruled out. Over the course of her illness, slow rehydration was maintained with a gradual decrease (10 mEq per 24 hours) of the serum sodium. Despite this care, she developed quadriparesis, and magnetic resonance imaging performed on day 6 of her illness was consistent with osmotic demyelination (central pontine myelinolysis). To rule out an excessively rapid correction of hypernatremia as the etiology of the problem, a myelin basic protein was measured in the cerebrospinal fluid that had been obtained on hospital day 1. The myelin basic protein was 649.50 ng/mL (normal, 0.07-4.10 ng/mL). The current literature is presented regarding the postulated pathogenesis of central pontine myelinolysis and suggested therapies, previous reports of central pontine myelinolysis in children are reviewed, and the potential role of myelin basic protein in its diagnosis is discussed.

show abstract

Central Pontine Myelinolysis in a Previously Healthy 4-Year-Old Child With Acute Rotavirus Gastroenteritis

Cited by 27 publications

References 24 publications

Acute Ataxia in an Infant

Acute Ataxia in an Infant

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Osmotic Demyelination and Hypertonic Dehydration in a 9-Year-Old Girl: Changes in Cerebrospinal Fluid Myelin Basic Protein

Contact Info

Product

Resources

About