1.Central pontine myelinolysis: a rare presentation secondary to hyperglycaemia.
Monica SAINI ; Marlie Jane MAMAUAG ; Rajinder SINGH
Singapore medical journal 2015;56(4):e71-3
Central pontine myelinolysis (CPM) is classically described as a demyelinating condition that results from the rapid correction of hyponatraemia. CPM has also been reported to arise from hyperglycaemia in association with concomitant acidosis, hypernatraemia and hyperosmolar syndrome. Herein, we report a rare presentation of CPM, which was purely secondary to hyperosmolar hyperglycaemia. The patient presented with ataxia and pseudobulbar affect, which evolved subacutely over a duration of two weeks. It is important to note that, in addition to acute changes in osmolality, a subacute shift secondary to hyperglycaemia may also lead to CPM.
Diagnosis, Differential
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Female
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Humans
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Hyperglycemia
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complications
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Magnetic Resonance Imaging
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Middle Aged
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Myelinolysis, Central Pontine
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diagnosis
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etiology
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Tomography, X-Ray Computed
3.Central Pontine Myelinolysis in a Patient with Acute Lymphoblastic Leukemia after Hematopoietic Stem Cell Transplantation: A Case Report.
Kyu Hyoung LIM ; Sunyoung KIM ; Yoon Su LEE ; Ki Hwan KIM ; Jinwon KIM ; Ji Young RHEE ; Hye Jin KIM ; Hyeon Gyu YI ; So Yeon OH ; Joo Han LIM ; Sae Won HAN ; Sangyoon LEE ; Inho KIM ; Sung Soo YOON ; Seonyang PARK ; Byoung Kook KIM
Journal of Korean Medical Science 2008;23(2):324-327
We describe a 37-yr-old man who developed central pontine myelinolysis (CPM) after allogeneic hematopoietic stem cell transplantation (HSCT) for acute lymphoblastic leukemia. After HSCT, desquamation developed on the whole body accompanied by hyperbilirubinemia. The liver biopsy of the patient indicated graft-versus-host disease- related liver disease, and the dose of methylprednisolone was increased. Then, the patient developed altered mentality with eye ball deviation to the left, for which electroencephalogram and magnetic resonance imaging (MRI) scans were done. Brain MRI scan demonstrated the imaging findings consistent with central pontine myelinolysis and extrapontine myelinolysis. He did not have any hyponatremia episode during hospitalization prior to the MRI scan. To the best of our knowledge, presentation of CPM after allogeneic HSCT is extremely rare in cases where patients have not exhibited any episodes of significant hyponatremia. We report a rare case in which hepatic dysfunction due to graft-versus-host disease has a strong association with CPM after HSCT.
Adult
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Biopsy
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Brain/pathology
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Electroencephalography
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Graft vs Host Disease
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Hematopoietic Stem Cell Transplantation/*adverse effects
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Humans
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Hyperbilirubinemia/etiology
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Liver/pathology
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Magnetic Resonance Imaging
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Male
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Myelinolysis, Central Pontine/complications/*etiology
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Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/*therapy
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Time Factors
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Treatment Outcome
4.The possible causes of central pontine myelinolysis after liver transplantation.
Jun YU ; Ting-bo LIANG ; Shu-sen ZHENG ; Yan SHEN ; Wei-lin WANG ; Qing-hong KE
Chinese Journal of Surgery 2004;42(17):1048-1051
OBJECTIVETo sum up the clinical characteristics of patients with central pontine myelinolysis (CPM) after orthotopic liver transplantation (OLT) and to document the possible causes on CPM.
METHODS142 patients' data with OLT between January 1999 to May 2003 were analyzed retrospectively. The following risk factors during preoperation were analyzed between patients with and without CPM: primary liver disease, preoperative serum sodium level, magnesium level and plasma osmolality, fluctuation degree of serum sodium concentration, and immunosuppressive drugs level etc.
RESULTSA total of 13 (9.2%) neurologic symptoms appeared in 142 patients post operation, including 5 cases (3.5%) with CPM and 8 cases (5.6%) with cerebral hemorrhage or infarct. 2 patients who developed CPM after OLT had hyponatremia history before operation (serum sodium <130 mmol/L), and the mean serum sodium level was (130.6 +/- 5.54) mmol/L. The serum sodium level was significantly lower in CPM than that of patients without neurologic complication or with cerebral hemorrhage/infarct (P <0.05). The rises of serum sodium perioperative 48 h after OLT in patients with CPM was significantly greater than that in patients with cerebral hemorrhage/infarct or no neurologic complication (19.5 +/- 6.54) mmol/L, (10.1 +/- 6.43) mmol/L, (4.5 +/- 4.34) mmol/L, respectively, (P < 0.05). Plasma osmolality increased greatly postoperatively in patients with CPM. Hypomagnesemia was noted in all patients perioperatively, but there was not significant difference among groups. The duration of operation in CPM was longer than in others (492 +/- 190.05) min (P <0.05). Cyclosporin A (CsA) levels were normal in all patients, but there was significant difference between patients with and without neurologic complication (P <0.05).
CONCLUSIONSCPM may be more prevalent following liver transplantation. Although the diagnosis of CPM after OLT can be made by complete neurologic evaluation including magnetic resonance imaging (MRI) of the head, the mortality is still very high. The occurrence of CPM may be associated with hyponatremia, rapid rise of serum sodium concentration, postoperative increase of plasma osmolality, the duration of operation and high CsA levels.
Adult ; Aged ; Cyclosporine ; adverse effects ; therapeutic use ; Female ; Humans ; Hyponatremia ; complications ; Immunosuppressive Agents ; adverse effects ; therapeutic use ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Monitoring, Intraoperative ; Myelinolysis, Central Pontine ; etiology ; Retrospective Studies ; Sodium ; blood ; Transplantation, Homologous