Central pontine myelinolysis: sequele of hyponatremia during transcervical resection of endometrium

Abstract

Transcervical resection of endometrium is an alternative to hysterectomy for women with menorrhagia. The procedure involves the use of cutting loop diathermy to resect the endometrium while the uterine cavity is irrigated with 1.5% glycine which can absorb consequent fluid and electrolyte shifts. Severe hyponatremia leading to central pontine myelinolysis is an extremely rare complication of this procedure. We report a case of a young female undergoing transcervical resection of endometrium for menorrhagia, who developed central pontine myelinolysis but made a complete recovery after three months.

Clinical practice guideline on diagnosis and treatment of hyponatraemia

“…We found 54 cases (63% female, median age 45 years, interquartile range 45-58 years) of osmotic demyelination syndrome published since 1997: 45 individual case reports and three case series including a total of nine patients (72,129,130,131,132,133,134,135,136,137,138,139,140,141,142,143,144,145,146,147,148,149,150,151,152,153,154,155,156,157,158,159,160,161,162,163,164,165,166,167,168,169,170,171,172,173,174,175). In 96% (52/54), the diagnosis of osmotic demyelination syndrome was based on magnetic...…”

Central Pontine and Extrapontine Myelinolysis in Children

“…Presentations include spastic tetraparesis, quadriparesis, pseudobulbar paralysis, coma, seizures, and the “locked in syndrome.” 2 –5 Though the very rare idiopathic case has been reported, 6 –8 typically central pontine and extrapontine myelinolysis have been attributed to either very high or very low levels of serum sodium, 9 –11 including the overly aggressive and rapid correction of hyponatremia. 4,12 –17 Alcoholics, 2,18 –22 liver transplant recipients, 23 –31 and patients with hyperosmolar states comprise the majority of remaining cases. 32 However, it also has been described in association with other electrolyte imbalances including hypophosphatemia 33 –35 and hypokalemia; 36 –38 acute hepatitis; 39 –41 renal failure; 15,42,43 hemodialysis; 15,43 emesis gravidarum; 14,37 anorexia nervosa; 44,45 diabetes mellitus; 10,46,47 Wilson disease; 48,49 leukemia; 50,…”