J Korean Neurosurg Soc.  2016 Mar;59(2):161-164. 10.3340/jkns.2016.59.2.161.

Preoperative Extrapontine Myelinolysis with Good Outcome in a Patient with Pituitary Adenoma

• Zhou Y
• Zhu Y
• Wang W
• Xing B

• KMID: 2192048
• DOI: http://doi.org/10.3340/jkns.2016.59.2.161

Abstract

Few preoperative extrapontine myelinolysis (EPM) cases with pituitary adenoma have been reported. No such case had long follow-up to see the outcome of EPM. We reported a 38-year-old man complaining of nausea, malaise and transient loss of consciousness who was found to have severe hyponatremia. Neurologic deficits including altered mental status, behavioral disturbances, dysarthria and dysphagia developed despite slow correction of hyponatremia. Endocrine and imaging studies revealed hypopituitarism, nonfunctional pituitary macroadenoma and extrapontine myelinolysis. Transsphenoidal surgery was performed after three weeks of supportive therapy, when neurological symptoms improved significantly. The patient recovered function completely 3 months after surgery. Our case indicates that outcome of EPM can be good even with prolonged periods of severe neurologic impairment.

Keyword

Extrapontine myelinolysis; Hyponatremia; Outcome; Pituitary adenoma; Preoperative

MeSH Terms

Adult
Deglutition Disorders
Dysarthria
Follow-Up Studies
Humans
Hyponatremia
Hypopituitarism
Myelinolysis, Central Pontine*
Nausea
Neurologic Manifestations
Pituitary Neoplasms*
Unconsciousness

Figure

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  Fig. 1 Preoperative pituitary and cranial MRI. Pituitary coronal T1-weighted images (T1WI) and T2WI show an isointense lesion (18 mm×29 mm×20 mm) in sella region which extends inferiorly into sphenoidal sinus and superiorly into suprasellar cistern with slight compression of optic chiasm (A and B). The mass is homogeneously enhanced (C). Cranial axial T2WI and fluid-attented inversion recovery (FLAIR) show bilateral basal ganglion and thalamus extrapontine myelinolysis (D and E). No obvious central pontine myelinolysis is found (F).

• 

  Fig. 2 Follow-up MRI 7 months after operation. Pituitary coronal and sagittal enhanced MR-images show no obvious residual adenoma (A and B). Cranial axial T2WI and FLAIR show extrapontine myelinolysis resolved at bilateral basal ganglion and thalamus (C and D).

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