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Pontine Myelinolysis and Delayed Encephalopathy Following the Rapid Correction of Acute Hyponatremia

Pontine Myelinolysis and Delayed Encephalopathy Following the Rapid Correction of Acute Hyponatremia Abstract • We describe a case of pontine myelinolysis associated with hyponatremia and hyperammonemia resulting from bladder irrigation during a transurethral prostatic resection. Following the procedure the patient exhibited seizurelike activity. He underwent rapid correction of the hyponatremia, he initially recovered but developed encephalopathy 19 days later. Magnetic resonance images showed symmetrical lesions in the white matter of the cerebellar peduncles. A relatively small pontine lesion was also noted. The patient later recovered. This case demonstrates that myelinolysis associated with rapid correction of hyponatremia may be greater in the cerebellar peduncles than in the central pons. References 1. Adams RD, Victor M, Mancall EL. Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients . Arch Neurol Psychiatry . 1959;81:154-172.Crossref 2. Rippe DJ, Edwards MK, D'Amour PG, Holden RW, Roos KL. MR imaging of central pontine myelinolysis . J Comput Assist Tomogr . 1987;11:724-726.Crossref 3. Thompson DS, Hutton JT, Stears JC, Sung JH, Norenberg M. Computerized tomography in the diagnosis of central and extrapontine myelinolysis . Arch Neurol . 1981;38:243-246.Crossref 4. Creel DJ, Wang JM, Wong KC. Transient blindness associated with transurethral resection of the prostate . Arch Ophthalmol . 1987;28:1537-1539.Crossref 5. Harrison RH, Boren JS, Robison JR. Dilutional hyponatremic shock: another concept of the transurethral prostatic resection reaction . J Urol . 1956;75:95-110. 6. Sterns JH, Riggs JE, Schochet SS. Osmotic demyelination syndrome following rapid correction of hyponatremia . N Engl J Med . 1986;314:1535-1542.Crossref 7. Ayus JC, Krothapalli RK, Arieff AI. Treatment of symptomatic hyponatremia and its relation to brain damage . N Engl J Med . 1987;317:1190-1195.Crossref 8. Norenberg MD, Papendick RE. Chronicity of hyponatremia as a factor in experimental myelinolysis . Ann Neurol . 1984;15:544-547.Crossref 9. Illowsky BP, Laureno R. Encephalopathy and myelinolysis after rapid correction of hyponatremia . Brain . 1987;110:855-868.Crossref 10. Sterns RH. Severe symptomatic hyponatremia: treatment and outcome: a study of 64 cases . Ann Intern Med . 1987;107:656-664.Crossref 11. Boon AP, Potter AE. Extensive extrapontine and central myelinolysis associated with correction of profound hyponatremia . Neuropathol Appl Neurobiol . 1987;13:1-9.Crossref 12. Wright DG, Laureno R, Victor M. Pontine and extrapontine myelinolysis . Brain . 1979;102:361-385.Crossref 13. Norenberg MD. A hypothesis of osmotic endothelial injury . Arch Neurol . 1983;40:66-69.Crossref 14. Dickoff DJ, Raps M, Yahr MD. Striatal syndrome following hyponatremia and its rapid correction: a manifestation of extrapontine myelinolysis and its rapid correction . Arch Neurol . 1988;45:112-114.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Pontine Myelinolysis and Delayed Encephalopathy Following the Rapid Correction of Acute Hyponatremia

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Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1989.00520440122030
Publisher site
See Article on Publisher Site

Abstract

Abstract • We describe a case of pontine myelinolysis associated with hyponatremia and hyperammonemia resulting from bladder irrigation during a transurethral prostatic resection. Following the procedure the patient exhibited seizurelike activity. He underwent rapid correction of the hyponatremia, he initially recovered but developed encephalopathy 19 days later. Magnetic resonance images showed symmetrical lesions in the white matter of the cerebellar peduncles. A relatively small pontine lesion was also noted. The patient later recovered. This case demonstrates that myelinolysis associated with rapid correction of hyponatremia may be greater in the cerebellar peduncles than in the central pons. References 1. Adams RD, Victor M, Mancall EL. Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients . Arch Neurol Psychiatry . 1959;81:154-172.Crossref 2. Rippe DJ, Edwards MK, D'Amour PG, Holden RW, Roos KL. MR imaging of central pontine myelinolysis . J Comput Assist Tomogr . 1987;11:724-726.Crossref 3. Thompson DS, Hutton JT, Stears JC, Sung JH, Norenberg M. Computerized tomography in the diagnosis of central and extrapontine myelinolysis . Arch Neurol . 1981;38:243-246.Crossref 4. Creel DJ, Wang JM, Wong KC. Transient blindness associated with transurethral resection of the prostate . Arch Ophthalmol . 1987;28:1537-1539.Crossref 5. Harrison RH, Boren JS, Robison JR. Dilutional hyponatremic shock: another concept of the transurethral prostatic resection reaction . J Urol . 1956;75:95-110. 6. Sterns JH, Riggs JE, Schochet SS. Osmotic demyelination syndrome following rapid correction of hyponatremia . N Engl J Med . 1986;314:1535-1542.Crossref 7. Ayus JC, Krothapalli RK, Arieff AI. Treatment of symptomatic hyponatremia and its relation to brain damage . N Engl J Med . 1987;317:1190-1195.Crossref 8. Norenberg MD, Papendick RE. Chronicity of hyponatremia as a factor in experimental myelinolysis . Ann Neurol . 1984;15:544-547.Crossref 9. Illowsky BP, Laureno R. Encephalopathy and myelinolysis after rapid correction of hyponatremia . Brain . 1987;110:855-868.Crossref 10. Sterns RH. Severe symptomatic hyponatremia: treatment and outcome: a study of 64 cases . Ann Intern Med . 1987;107:656-664.Crossref 11. Boon AP, Potter AE. Extensive extrapontine and central myelinolysis associated with correction of profound hyponatremia . Neuropathol Appl Neurobiol . 1987;13:1-9.Crossref 12. Wright DG, Laureno R, Victor M. Pontine and extrapontine myelinolysis . Brain . 1979;102:361-385.Crossref 13. Norenberg MD. A hypothesis of osmotic endothelial injury . Arch Neurol . 1983;40:66-69.Crossref 14. Dickoff DJ, Raps M, Yahr MD. Striatal syndrome following hyponatremia and its rapid correction: a manifestation of extrapontine myelinolysis and its rapid correction . Arch Neurol . 1988;45:112-114.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Aug 1, 1989

References