Seasonal postpartum hypernatremic encephalopathy with osmotic extrapontine myelinolysis and rhabdomyolysis

Naik, Karkal Ravishankar; Saroja, Aralikatte Onkarappa

doi:10.1016/j.jns.2010.01.014

Cited by 35 publications

(55 citation statements)

References 28 publications

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“…Complete neuroradiologic recovery was documented in 3 patients. [12][13][14] Residual findings in the form of brain atrophy, 23 decrease in ODS-related T2 signal intensities, 26,27,30 and patchy contrast enhancement 23 were reported.…”

Section: Clinical Outcome and Follow-upmentioning

confidence: 99%

“…Only 2 studies also used DWI and ADC mapping. 30,76 The potential advantage of using DWI and ADC stems from the role of cytotoxic and vasogenic edema in the development of lesions, especially in white matter regions, given its highly compartmentalized structure. Using serial ADC mapping at different time points after the onset of symptoms showed lower ADC values early after the onset of symptoms and a gradual increase to normal or above-normal values thereafter.…”

Section: Cerebral Volume Changesmentioning

confidence: 99%

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Clinical Semiology and Neuroradiologic Correlates of Acute Hypernatremic Osmotic Challenge in Adults: A Literature Review

Ismail¹,

Szóllics

Szólics

et al. 2013

AJNR Am J Neuroradiol

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SUMMARY:The complex interplay between hypernatremic osmotic disturbances and cerebral lesions is yet to be clarified. In this review, we discuss, on the basis of the reported data of hypernatremic CNS challenge in the adult population, the clinical and radiologic features of the condition. Our search captured 20 case studies and 1 case series with 30 patients in total who acquired acute hypernatremia due to different etiologies and developed CNS lesions. We explored the associations between premorbid conditions, clinical presentation, hypernatremic state, correction rate, and radiologic appearance, including the localization of brain lesions and the outcomes. The results revealed that altered mental status was the most commonly reported symptom and osmotic demyelination syndrome in the form of extrapontine myelinolysis was the prevailing radiologic pattern. Finally, we contrasted, when appropriate, clinical and experimental data related to hypernatremic and hyponatremic osmotic insults to aid the understanding of the pathophysiology of CNS osmotic brain injury.ABBREVIATIONS: BG ϭ basal ganglia; CPM ϭ central pontine myelinolysis; EPM ϭ extrapontine myelinolysis; GCS ϭ Glasgow Coma Scale; ODS ϭ osmotic

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Section: Clinical Outcome and Follow-upmentioning

confidence: 99%

Section: Cerebral Volume Changesmentioning

confidence: 99%

Clinical Semiology and Neuroradiologic Correlates of Acute Hypernatremic Osmotic Challenge in Adults: A Literature Review

Ismail¹,

Szóllics

Szólics

et al. 2013

AJNR Am J Neuroradiol

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“…[1] Extrapontine myelinolysis, a fairly common metabolic disorder, is associated with neurological complications. Central pontine and extrapontine myelinolysis are commonly recognized with rapid correction of sodium.…”

Section: Introductionmentioning

confidence: 99%

Cerebral encephalopathy with extrapontine myelinolysis in a case of postpartum hypernatremia

Bhatia

Kapoor

Sharma

et al. 2014

Indian Journal of Radiology and Imaging

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Extrapontine myelinolysis, a fairly common metabolic disorder, is associated with neurological complications. Central pontine and extrapontine myelinolysis are commonly recognized with rapid correction of sodium. Myelinolysis, however, has rarely been described with hypernatremia. We report a rare case of post-partum hypernatremic encephalopathy associated with serum sodium levels as high as 200 mEq/l on presentation. Although the serum sodium levels were brought down gradually, subsequent imaging showed progression of demyelination and deterioration of the neurological status.

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“…The brain injury that occurs with hypernatremia has been postulated to result in part from shrinkage of the brain away from the skull causing mechanical stress on vessels that could lead to hemorrhage and or ischemia. As evidenced by multiple case reports, rapid, severe elevations of PNa can result in ODS even in the absence of previous hyponatremia [62 ]. Hypernatremic patients may display irritation, agitation, lethargy, depressed mental status, seizures, and coma.…”

Section: Hypernatremiamentioning

confidence: 99%

Dysnatremia in the ICU

Pokaharel

Block

2011

Current Opinion in Critical Care

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Seasonal postpartum hypernatremic encephalopathy with osmotic extrapontine myelinolysis and rhabdomyolysis

Cited by 35 publications

References 28 publications

Clinical Semiology and Neuroradiologic Correlates of Acute Hypernatremic Osmotic Challenge in Adults: A Literature Review

Clinical Semiology and Neuroradiologic Correlates of Acute Hypernatremic Osmotic Challenge in Adults: A Literature Review

Cerebral encephalopathy with extrapontine myelinolysis in a case of postpartum hypernatremia

Dysnatremia in the ICU

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