Mielinolise pontina central e extra-pontinas: apresentação de um caso autopsiado e revisão da literatura

Pittella, José Eymard Homem; Gobbi, Helenice

doi:10.1590/s0004-282x1987000300011

Cited by 4 publications

(5 citation statements)

References 34 publications

(9 reference statements)

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“…Embora a etiopatogênese da desmielinização seja ainda discutida admite-se que a correção rápida do sódio plasmático em pacientes com hiponatremia tenha papel fundamental através de injúria vascular osmótica da barreira hemato-encefálica, resultando em edema e desmielinização em áreas que, como a base da ponte, exibem substâncias cinzenta e branca intimamente justapostas. 9 Para correção da hiponatremia, recomenda-se que seja feita a correção de forma lenta, elevando o sódio em menos de 10 mEq/L nas primeiras 24 horas (ideal de 6 a 8 mEq/L) e menos que 18 mEq/L nas primeiras 48 horas.…”

Section: Discussionunclassified

Mielinólise pontina central associada a movimento ocular “bobbing” : relato de caso

Oliveira¹,

Paiva²,

Quirino³

et al. 2022

HRJ

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RESUMO Introdução: A mielinólise pontina central (MPC) é uma doença desmielinizante aguda causada por oscilações abruptas na osmolalidade sérica, que resulta na desmielinização simétrica da parte central da base da ponte. Descrição: Paciente de 60 anos deu entrada no Pronto Socorro de um hospital do DF, com quadro de confusão mental iniciados há 07 dias, sem outras queixas. Ao exame físico estava em regular estado geral, glasgow 12, apresentando confusão mental, normotenso, normocardio e afebril. Pupilas isocóricas, fotorragenfes, sem rigidez de nuca, tetraplegia sequelar a um trauma raquimedular há 33 anos. Negava comorbidades e não fazia uso de medicação contínua. Sua TC de crânio realizada no 10º dia após rebaixamento do sensório evidenciou hipodensidade difusa e simétrica na ponte associada a edema, com apagamento das cisternas peripontinas. Devido à instabilidade do quadro, o paciente não conseguiu realizar o exame de ressonância magnética de crânio. Ao exame neurológico após retirada da sedação e desmame dos anticonvulsivantes, apresentava movimento ocular vertical com deslocamento rápido dos olhos para baixo, seguindo de retorno lento a posição inicial, denominado “BOBBING”. A etiologia da hiponatremia grave não foi esclarecida. O paciente evoluiu a óbito. Conclusões: A mielinólise pontina central é uma patologia desmielinizante do encéfalo associada principalmente com a correção rápida da hiponatremia, manifestando-se especialmente por tetraparesia espástica e paralisia pseudo-bulbar. A evolução destes pacientes é variável desde a sua recuperação total sem sequelas até o óbito, tendo geralmente, recuperação lenta e gradativa.

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Section: Discussionunclassified

Mielinólise pontina central associada a movimento ocular “bobbing” : relato de caso

Oliveira¹,

Paiva²,

Quirino³

et al. 2022

HRJ

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“…The proposed mechanism for the development of ODS varied among the cases but overall included severe acidosis (pH < 7.0), aggressive fluid resuscitation, hyperosmolar therapy, bacteremia with possible meningitis, and wide fluctuations in glucose, sodium, or osmolarity. One patient died and the remaining four survived with full or near full recovery [ 5 , 7 , 8 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…ODS was historically thought to be fatal or to result in severe neurologic deficits including locked-in syndrome. However, in the last 30 years there have been increasing numbers of pediatric cases with complete or near-complete recovery [ 5 , 7 , 8 , 13 , 14 , 30 ]. This shift in outcome is possibly due to improved identification and advancement in medical care.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of CE in DKA is approximately 1%; however, when it occurs, it accounts for 57-87% of DKA related mortality and 10-26% of morbidity [ 2 ]. Other neurologic complications of DKA include central nervous system infarction, thrombosis, transient grey and white matter changes, and osmotic demyelination [ 2 – 8 ]. The osmotic demyelination syndrome (ODS) consisting of central and extra pontine myelinolysis is a relatively rare complication of DKA.…”

Section: Introductionmentioning

confidence: 99%

“…Central pontine myelinolysis (CPM) was originally described as a complication of rapid correction of hyponatremia, particularly in the setting of malnutrition, alcohol abuse, and liver disease [ 9 , 10 ]. Demyelination is now believed to occur secondary to rapid osmotic shifts from changes in any osmotically active agent including sodium, potassium, glucose, and ammonia [ 5 – 8 , 11 , 12 ]. To the best of our knowledge, only five other cases of ODS have been reported in association with pediatric DKA [ 5 , 7 , 8 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Central Pontine Myelinolysis in Pediatric Diabetic Ketoacidosis

Kinoshita

Grant

Xoinis

et al. 2018

Case Reports in Critical Care

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Central pontine myelinolysis (CPM) is rarely reported in pediatric patients with diabetic ketoacidosis (DKA). We report this case of a 16-year-old female with new onset diabetes presenting with DKA, who received aggressive fluid resuscitation and sodium bicarbonate in the emergency department. Later she developed altered mental status concerning for cerebral edema and received hyperosmolar therapy with only transient improvement. Soon she became apneic requiring emergent endotracheal intubation. MRI brain showed cerebral edema, CPM, and subdural hemorrhage. She was extubated on day seven and exhibited mild dysmetria, ataxia, unilateral weakness, and neglect. Upon discharge she was able to ambulate with a walker and speak and eat without difficulty. Although less common than cerebral edema, CPM should be considered in DKA patients with acute neurologic deterioration. Fluid and bicarbonate therapy should be individualized, but larger studies would help guide the management. Although poor outcomes are reported in CPM, favorable outcomes are possible.

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Central Pontine and Extrapontine Myelinolysis in Children

et al. 2012

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This study aimed to identify the causes and contributing factors, neurologic presentation, and outcomes of central pontine and extrapontine myelinolysis and to examine any trends in the presentation and course of these disorders over the past 50 years. Seventy-six pediatric cases were identified in the literature. Age, sex, decade of diagnosis, neurologic presentation, outcome, and attributed causes were extracted. The results showed that the diagnosis, course, and outcomes of central pontine and extrapontine myelinolysis clearly have changed over the past few decades. Early cases generally were diagnosed at autopsy as opposed to computed tomography or magnetic resonance imaging more recently. Ninety-four percent of cases prior to 1990 and only 7% of cases from 1990 onward resulted in patient mortality. The decade in which the case was reported was the strongest predictor of outcome (P < .001), followed by sodium dysregulation (P = .045) and dehydration (P = .07).

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Mielinolise pontina central e extra-pontinas: apresentação de um caso autopsiado e revisão da literatura

Cited by 4 publications

References 34 publications

Mielinólise pontina central associada a movimento ocular “bobbing” : relato de caso

Mielinólise pontina central associada a movimento ocular “bobbing” : relato de caso

Central Pontine Myelinolysis in Pediatric Diabetic Ketoacidosis

Central Pontine and Extrapontine Myelinolysis in Children

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