Cerebral encephalopathy with extrapontine myelinolysis in a case of postpartum hypernatremia

Bhatia, Sonia; Kapoor, Ankur; Sharma, Anurag; Gupta, Rajiv; Kataria, Sushila

doi:10.4103/0971-3026.130697

Cited by 14 publications

(10 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similar cases of hypernatremia myelinolysis have been reported in literature, which were treated with parenteral fluids and steroids [1,2]. Rapid correction of hyponatremia is a well-known cause of central pontine and extrapontinemyelinolysis.…”

Section: Discussionsupporting

confidence: 63%

Wine Glass Sign and Empty Delta Sign: A Rare Imaging Presentation of Postpartum Encephalopathy in Dehydration

Chavadi

Suprasanna

Dudekula

et al. 2016

JCDR

View full text Add to dashboard Cite

A 29-year-old female presented to the Emergency Department with history of altered sensorium, irrelevant talking and fever since 3 days, left hemiparesis since one day and generalized tonic clonic seizures on the day of admission. She had delivered a full term baby 17 days back. There was no significant antenatal or perinatal history. The patient was not a known hypertensive or diabetic.On general physical examination the pulse rate was 110/min, blood pressure 110/70 mm of Hg, respiratory rate 24/min and body temperature of 100 0 F. On examination she had altered higher mental functions, left upper limb power of 0/5, left lower limb power of 2/5 and right side limbs power was normal. Examination of other systems was unremarkable. Biochemical investigations were as follows: Sodium-164 mEq/L, Potassium-3.5 mEq/L, total leucocyte count-8200 cells/µL, Hb-9 gm/dl, Platelet-2 lac/cu mm, PT/INR-normal. No electrolyte correction was done prior to MRI examination.

show abstract

Section: Discussionsupporting

confidence: 63%

Wine Glass Sign and Empty Delta Sign: A Rare Imaging Presentation of Postpartum Encephalopathy in Dehydration

Chavadi

Suprasanna

Dudekula

et al. 2016

JCDR

View full text Add to dashboard Cite

show abstract

“…6 Naik et al reported elevated serum CK levels in nine out of eleven patients. 2 Elevated cretine kinase level in postpartum hypernatremia is also reported by Bhatia et al 7 and Suri et al 8 All our patients had hypermagnesemia which can be explained by acute kidney injury. All patients had normal calcium levels.…”

supporting

confidence: 81%

Clinical and neuroimaging profile in postpartum hypernatremia

2020

IJN

View full text Add to dashboard Cite

Hypernatremia can cause encephalopathy, rhabdomyolysis, and osmotic demyelination. Postpartum hypernatremia is an uncommon occurrence. The present study attempts to highlight clinical and radiological profile of three patients who had postpartum hypernatremia and to provide differential diagnosis of magnetic resonance imaging findings of postpartum hypernatremia. Aim: To study clinical and radiological profile of three patients who had postpartum hypernatremia and to provide differential diagnosis of magnetic resonance imaging findings of postpartum hypernatremia. Material and Methods: The present study was conducted in a tertiary care centre in South India between March 2014 to March 2018. Three patients had hypernatremia presenting in postpartum period. Demographic data, clinical details, results of laboratory examinations and neuroimaging details of these patients were recorded. Result: All three patients had hypernatremia presenting with encephalopathy. Spasticity was seen in all patients. Quadriparesis was seen in two patients. One patient had generalized tonic clonic seizures. Two patients had hypokalemia. All the three patients had Hyperchloremia, Azotemia and raised serum osmolality. Phosphorous levels was high in one patient. Creatine kinase levels was high in one patient. All patients had hypermagnesemia and normal calcium levels. Thrombocytopenia was seen in one patient. On neuroimaging, splenium of corpus callosum, hippocampus and posterior limb of internal capsule were involved in all patients. Cerebral peduncles in two patients. Corona Radiata and cerebellar white matter were involved in one patient. Conclusion:Early identification and meticulous management of hypernatremia is of paramount importance. Neuroimaging Findings in postpartum hypernatremia is distinct.

show abstract

“…[1011] It also occurred with gradual correction of hyponatremia as well as in normonatremic and hypernatremic patients. [12131415] Several conditions predisposing patients to its development were also found. These include renal failure patients on dialysis, liver failure, and transplantation, malignancies such as lymphoma, carcinoma, cachexia, sepsis, acute pancreatitis, pellagra, and chronic alcoholism.…”

Section: Discussionmentioning

confidence: 99%

Osmotic Demyelination Syndrome - Evolution of Extrapontine Before Pontine Myelinolysis on Magnetic Resonance Imaging

Garg

Aggarwal

Malhotra

et al. 2019

Journal of Neurosciences in Rural Practice

View full text Add to dashboard Cite

Osmotic demyelination syndrome is a rare entity characterized by noninflammatory demyelination afflicting the central pons, basal ganglia, thalami, peripheral cortex, and hippocampi. Histopathologically, there is a destruction of myelin sheaths sparing the underlying neuronal axons due to the susceptibility of oligodendrocytes to rapid osmotic shifts often encountered in chronically debilitated patients. We present the temporal progression of signal abnormalities on sequential magnetic resonance imaging (MRI) scans in a middle-aged male initially presenting with altered mental status due to severe hyponatremia and subsequently developing rigidity, diagnosed as osmotic demyelination syndrome based on typical imaging findings and supportive laboratory parameters. This case demonstrates the importance of diffusion signal abnormalities as the first indicator of osmotic demyelination, evolution of extrapontine before pontine signal changes and the relative lack of correlation between patient's clinical profile and the extent of MRI signal abnormalities.

show abstract

Cerebral encephalopathy with extrapontine myelinolysis in a case of postpartum hypernatremia

Cited by 14 publications

References 10 publications

Wine Glass Sign and Empty Delta Sign: A Rare Imaging Presentation of Postpartum Encephalopathy in Dehydration

Wine Glass Sign and Empty Delta Sign: A Rare Imaging Presentation of Postpartum Encephalopathy in Dehydration

Clinical and neuroimaging profile in postpartum hypernatremia

Osmotic Demyelination Syndrome - Evolution of Extrapontine Before Pontine Myelinolysis on Magnetic Resonance Imaging

Contact Info

Product

Resources

About