Hyponatremia and extrapontine myelinolysis in a patient with COVID‐19: A case report

Rehman, Muhammad Abd Ur; Abdulrahman, Abdulrahman Fadhl; Zainab, Aariz; Paksoy, Yahya; Kharma, Nadir

doi:10.1002/ccr3.4463

Cited by 8 publications

(6 citation statements)

References 24 publications

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“…Recently, with the emergence of COVID-19, there have been several case reports and clinical encounters where ODS/CPM was reported [16,17]. However, all those were reported in the background of rapid correction of hyponatremia, which was not in our case though the patient was diagnosed for COVID-19 earlier.…”

Section: Discussionmentioning

confidence: 67%

Central Pontine Myelinolysis Secondary to Hyperglycemia in a Young Patient

Mir¹,

Shrestha²,

Aryal³

et al. 2021

Cureus

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Central pontine myelinolysis (CPM) is a neurological disorder typically caused by rapid correction of severe chronic hyponatremia. Conditions causing a hyperosmolar state can also cause CPM, but it is rarely seen in diabetes.Here we describe a case of a 34-year-old female with longstanding uncontrolled diabetes mellitus who presented with bilateral upper and lower limb weakness and dysphagia. Examination showed decreased muscle strength, and laboratory investigations showed high HbA1c, high blood glucose, increased serum osmolality, and normal sodium. A diagnosis of CPM was made after MRI showed restricted diffusion in the bilateral pons and CT showed pontine hypodensities. The patient was started on insulin therapy, and she showed clinical improvement with improving blood glucose levels. After five days of hospital stay, she was discharged home with appointments to neurology and endocrinology clinics.This case shows that CPM is a potential complication of uncontrolled diabetes mellitus in the presence of normal serum sodium. Timely treatment of hyperglycemia can lead to improvement of symptoms, but it is a potentially fatal condition. Thus, a diagnosis of CPM should be considered in diabetic patients who present with neurological symptoms and hyperglycemia.

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Section: Discussionmentioning

confidence: 67%

Central Pontine Myelinolysis Secondary to Hyperglycemia in a Young Patient

Mir¹,

Shrestha²,

Aryal³

et al. 2021

Cureus

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“…They adapt to this condition by reducing the intracellular tonicity through the transport of intracellular solutes to the extracellular compartment. In this way, the brain cells remove the excess water to prevent cerebral edema [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The description of other cases of patients with COVID-19 infection combined with ODS implies a connection between the two states and a possibility of considering the viral infection as a risk factor for the onset or progression of ODS [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Central Pontine Myelinolysis as a Late Complication After Hyponatremia and COVID-19 Infection

Ivanova¹,

Tsalta-Mladenov²,

Georgieva³

et al. 2023

Cureus

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Osmotic demyelination syndrome (ODS) is a rare but serious condition that is hypothesized to be a result of rapid correction of hyponatremia, with a catastrophic prognosis. The foci of demyelination may occur in either the pontine area or within the white matter of the cerebral hemispheres, which denotes a specific clinical presentation. We present the case of a post-COVID-19 patient who was diagnosed with ODS with typical clinical and radiological characteristics of both forms: central pontine myelinolysis and extrapontine myelinolysis. The clinical assessment of ODS encompasses a variety of differential diagnoses, including stroke, neuroinfection, neoplasia, and other demyelinating diseases. A specific characteristic of ODS is the delayed clinical manifestation after the hyponatremic state. Furthermore, it is noteworthy that there might be discrepancies between the clinical manifestations and the neuroimaging findings. The association between COVID-19 and ODS is unclear at the moment, although it can possibly be explained by the viral infection through multiple mechanisms such as renal dysfunction, diarrhea, or vomiting. ODS should be considered in cases of hyponatremia and neurological deterioration during the course of COVID-19 infection. Despite the fact that early detection and treatment of this syndrome can reduce the risk of shortterm mortality and long-term disability, they do not guarantee complete recovery.

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“…For patients with symptomatic recovery from hospitalized COVİD-19 infection, care should be taken in terms of fluid and electrolyte disorders that may develop later. A study mentions that COVID coinfection could also be a risk factor for the manifestation of extrapontine myelinolysis 4 . CPM was also reported to be not as rare as formerly known and to be responsible for most of the neurologic damage in patients with chronic hyponatremia 5 .…”

Section: Discussionmentioning

confidence: 99%

Central Pontine Myelinolysis as a Result of Ideally Corrected Hyponatremia in a Post-Covid Patient

GURBUZ

Taşlıdere

Emin

et al. 2022

Eurasian Journal of Critical Care

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Central pontine myelinolysis (CPM) is a non-inflammatory neurological condition with various clinical features and onset patterns and also with a very wide prognostic spectrum ranging from asymptomatic cases to encephalopathy and mortality. In this case report we, aim to present the first case of central pontine myelinolysis as a result of an optimally corrected hyponatremia in a post-COVID-19 patient our knowledge while assessing the clinical and radiological findings.

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Hyponatremia and extrapontine myelinolysis in a patient with COVID‐19: A case report

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 8 publications

References 24 publications

Central Pontine Myelinolysis Secondary to Hyperglycemia in a Young Patient

Central Pontine Myelinolysis Secondary to Hyperglycemia in a Young Patient

Central Pontine Myelinolysis as a Late Complication After Hyponatremia and COVID-19 Infection

Central Pontine Myelinolysis as a Result of Ideally Corrected Hyponatremia in a Post-Covid Patient

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