Reversible White Matter Lesions in a Patient with Fulminant Hepatitis and Acute Renal Failure.

Abstract

A 36-year-old man developed fulminant hepatitis and acute renal failure with profound hyponatremia (116 mEq/L). Emergent hemodialysis corrected the serum sodium to 136 mEq/L within 24 hours. He developed generalized convulsions ll days later. Magnetic resonance imaging (MRI) revealed a single large symmetrical lesion in the pons and extensive white matter lesions in the bilateral occipital, temporal, parietal and right frontal regions. These lesions showed marked resolution as the patient recovered. Fulminant hepatitis and acute renal failure could induce extensive edema in the cerebral white matter. Therefore, not all MRIabnormalities in the white matter after correction of hyponatremianecessarily reflect myelinolysis. (Internal Medicine 33: 360-362, 1994)

Reversible Hyperintense Lesion after Balloon Occlusion Test

“…In 1996, Hinchey described RPLS (reversible posterior leukoencephalopathy syndrome); this syndrome involves symmetrical reversible lesions in the subcortical white matter of the posterior cerebral hemispheres 8 . Vasogenic edema is considered as the main feature of this abnormality that is induced by various factors such as chronic hypertension, administration of immunosuppressive agents, eclampsia, liver dysfunction, renal failure, and hyponatremia 9–12 . These factors usually contribute to fluid retention.…”

“…8 Vasogenic edema is considered as the main feature of this abnormality that is induced by various factors such as chronic hypertension, administration of immunosuppressive agents, eclampsia, liver dysfunction, renal failure, and hyponatremia. [9][10][11][12] These factors usually contribute to fluid retention. Further, endothelial damage and increased vascular permeability may also contribute to the occurrence of vasogenic edema.…”

Fellows’ Forum in Dialysis edited by Mark A. Perazella: Does Uremia Protect against the Demyelination Associated with Correction of Hyponatremia during Hemodialysis? A Case Report and Literature Review

“…We performed a literature search looking for case reports of the rapid correction of hyponatremia in the dialysis population. Three were noted; two did not develop the demyelination syndrome (19,20). One patient with severe hyponatremia developed osmotic demyelination syndrome following hemodialysis (21).…”