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Zentrale pontine Myelinolyse nach ausgeprägter Hyponatriämie

Central pontine myelinolysis after severe hyponatremia

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Summary

Central pontine myelinolysis is a process of demyelinisation with variable neurological symptoms related to the localization. Predisposing factors are alcoholism and malnutrition. Rapid correction of severe hyponatremia is suspected to be a primary cause for central pontine myelinolysis. We report a 43 year old chronic alcoholic and polytoxicomanic female patient, who was admitted comatose with a serum sodium level of 94 mmol/l, caused by a syndrome of inappropriate ADH secretion. After initial improvement under careful sodium correction, the patients neurologic condition degraded progressively and within 4 weeks she developed a “locked-in”-syndrome. Only then the suspected central pontine myelinolysis could be demonstrated in nuclear magnetic resonance and computer tomography.

We presume that, although sodium correction was done relatively slowly in this patient, it probably contributed to her development of central pontine myelinolysis all the same.

Due to this case we review the literature on correction of hyponatremia, which shows growing evidence that it should start early but be continued very slowly (rise in serum-Na: max. 0,6 mmol/l/h) and requires frequent laboratory controls.

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Abbreviations

BGA:

Blutgasanalyse

Cat-Scan:

computer assisted tomography

CCT:

craniale Computertomographie

CPM:

Zentrale Pontine Myelinolyse (central pontine myelinolysis)

FAEP:

Frühe akustische evozierte Potentiale

KM:

Kontrastmittel

NMR:

nuclear magnetic resonance

NW:

Normalwert

SEP:

sensorische evozierte Potentiale

UKG:

Ultraschall-Kardiogramm

US:

Ultraschall

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Authors and Affiliations

  1. Medizinische Universitäts-Poliklinik der Philipps-Universität, Marburg

    J. A. Schmidt, A. Krause, C. O. Feddersen, F. V. Kohl & P. v. Wichert

  2. Radiologische Praxis, Zwesten

    G. Mariß

  3. Abteilung für Neuroradiologie der Philipps-Universität, Marburg

    A. Lütcke

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  1. J. A. Schmidt
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  2. A. Krause
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Schmidt, J.A., Krause, A., Feddersen, C.O. et al. Zentrale pontine Myelinolyse nach ausgeprägter Hyponatriämie. Klin Wochenschr 68, 191–198 (1990). https://doi.org/10.1007/BF01649086

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