Osmotc Demyelination Syndrome in a young patient, with hyponatremia and bad prognosis

• Autor(a) principal: Neto, Pedro Glória
• Data de Publicação: 2007
• Outros Autores: Neri, Vanderson Carvalho
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Revista Científica da Faculdade de Medicina de Campos
• Texto Completo: https://www.fmc.br/ojs/index.php/RCFMC/article/view/154
• topic: mielinólise; hiponatremia; desmielinização; myelinolisis; hyponatremia; demyelination

Introduction: The Osmotic Demyelination Syndrome is a disease characterized for edema and demyelination, without inflammation, including pons and extrapontines  areas. The predisponent factors include an underlying serious clinical illness (as the Addison´s disease, hepatic illness and cancer), nutricional deficiency, excessive alcoholic consumption and drugs, however, the great majority of the cases is related the hyponatremia or to its fast correction. Methods: Analysis and revision of handbook and literature. Case report: The authors describe the case of a unfed patient, with relate of excessive alcoholic consumption, that occured before the admission, vomitings, hiccups, anorexia and abuse of the ingestion of liquids until presenting gradual tetraparesia and Status Epilepticus, with signals of involviment of cranial pairs: asymmetric bilateral facial, choking and difficulty of deglutition, and diplopia in the lateral aimed ones. The Magnetic Resonance evidenced areas of demyelination in pons and areas of the cerebral white substance, and laboratorials evaluation had proven hyponatremia since the admission. Conclusion: The accurate mechanisms that generate edema and the demyelination are unknowed. It was observed that 78% of the patients with demyelination had presented hidroeletrolitics embalance or altered levels of blood gases. It is known that the metabolic factor is the most important in origin of the disease, and when it was not corrected, it can become irreversible injury. The presented case was diagnosed on clinical, radiological and laboratorial basis, confirming a Central Pontine Myelinolisis and an Extrapontine Myelinolisis, and because dealing with a serious compromeising, that can involve any medical speciality, is deserving of such description.