CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2014; 24(01): 57-60
DOI: 10.4103/0971-3026.130697
Neuroradiology

Cerebral encephalopathy with extrapontine myelinolysis in a case of postpartum hypernatremia

Sonia Bhatia
Department of Radiology, Medanta- The Medicity Hospital, Gurgaon, Haryana, India
,
Abhay Kumar Kapoor
Department of Radiology, Medanta- The Medicity Hospital, Gurgaon, Haryana, India
,
Anurag Sharma
Department of Internal Medicine, Medanta- The Medicity Hospital, Gurgaon, Haryana,India
,
Rajiv Gupta
Department of Radiology, Medanta- The Medicity Hospital, Gurgaon, Haryana, India
,
Sushila Kataria
Department of Internal Medicine, Medanta- The Medicity Hospital, Gurgaon, Haryana,India
› Author Affiliations

Abstract

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.



Publication History

Article published online:
02 August 2021

© 2014. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Naik KR, Saroja AO. Seasonal postpartum hypernatremic encephalopathy with osmotic extrapontine myelinolysis and rhabdomyolysis. J Neurol Sci 2010;291:5-11.
  • 2 Bekiesiñska-Figatowska M, Bulski T, Rózyczka I, Furmanek M, Walecki J. MR imaging of seven presumed cases of central pontine and extrapontine myelinolysis. Acta Neurobiol Exp (Wars) 200161:141-4.
  • 3 Graff-Radford J, Fugate JE, Kaufmann TJ, Mandrekar JN, Rabinstein. Clinical and radiologic correlations of central pontine myelinolysis syndrome. Mayo Clin Proc 2011;86:1063-7.
  • 4 Rego I, Vieira D, Correia F, Pereira JR. Multiple brain lesions in a young man with hypernatraemia. BMJ Case Rep 2012;2012:Pii: bcr1120115198.
  • 5 5 Yamada H, Takano K, Ayuzawa N, Seki G, Fujita T. Relowering of Serum Na for Osmotic Demyelinating Syndrome. Case Rep Neurol Med 2012;2012:704639.
  • 6 van der Helm-van Mil AH, van Vugt JP, Lammers GJ, Harinck. Hypernatremia from a hunger strike as a cause of osmotic myelinolysis. Neurology 2005;64:574-5.
  • 7 Sajith J, Ditchfield A, Katifi HA. Extrapontine myelinolysis presenting as acute parkinsonism. BMC Neurol 2006;6:33.
  • 8 Saroja AO, Naik KR, Mali RV, Kunam SR. �Wine Glass′ sign in recurrent postpartum hypernatremic osmotic cerebral demyelination. Ann Indian Acad Neurol 2013;16:106-10.
  • 9 Ahmed A, Loes DJ, Bressler EL. Reversible magnetic resonance imaging findings in metronidazole-induced encephalopathy. Neurology 1995;45:588-9.
  • 10 Singh S, Alexander M, Korah IP. Acute disseminated encephalomyelitis: MR imaging features. AJR Am J Roentgenol 1999;173:1101-7.
  • 11 Posterior Reversible Encephalopathy Syndrome: Prognostic Utility of Quantitative Diffusion-Weighted MR Images. Diego J. Covarrubias, Patrick H. Luetmer and Norbert G. Campeau. AJNR Am J Neuroradiol 2002;23:1038-48.
  • 12 Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: Current techniques, spectrum of findings, and diagnostic pitfalls Radiographics 2006;26:S19-41.