Korean J Neurotrauma.  2014 Apr;10(1):31-34. 10.13004/kjnt.2014.10.1.31.

Central Pontine and Extrapontine Myelinolysis in a Patient with Traumatic Brain Injury Following Not Rapid Correction of Hyponatremia: A Case Report

Affiliations
  • 1Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea. 72ysh@catholic.ac.kr

Abstract

Central pontine myelinolysis occurs inconsistently as a complication of severe and prolonged hyponatremia, particularly when corrected too rapidly. This condition is a concentrated, frequently symmetric, noninflammatory demyelination within the central basis pontis. We describe a head injury patient who developed central pontine and extrapontine myelinolysis following a gradual correction of hyponatremia. More attention should be paid to correcting hyponatremia combined with hypokalemia in patients who have a history of alcoholism.

Keyword

Central pontine myelinolysis; Hyponatremia; Head injury; Hypokalemia

MeSH Terms

Alcoholism
Brain Injuries*
Craniocerebral Trauma
Demyelinating Diseases
Humans
Hypokalemia
Hyponatremia*
Myelinolysis, Central Pontine*

Figure

  • FIGURE 1 Brain CT scan showing an epidural hematoma and contusion in the right temporal region.

  • FIGURE 2 Brain MR T2 images showing multiple contusions in the right temporal (A) and left frontal regions (B).

  • FIGURE 3 Diffusion-weighted image (A) showing high signal intensity with decreased ADC value (B) in both pons, the thalamus, and frontoparietal cortex (arrows). These lesions (asterisks) show high signal intensity on T2-weighted axial images (C). ADC: apparent diffusion coefficient.

  • FIGURE 4 Daily levels of serum sodium and potassium.


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