摘要
Introduction: Centropontine myelinolysis (CPM) is a rare pathology, a delayed neurological complication corresponding to massive demyelination of the protrusion. Its exact pathogenesis is poorly understood. Rapid correction of sodium hyponatremia has been implicated as a potent causative factor. We report a case of CPM despite a priori conservative correction of hyponatremia with a favorable course in a 61-year-old alcoholic-smoker diabetic. Case Presentation: A 61-year-old man with chronic alcoholism presented to the emergency department (D0) with physical asthenia and anorexia. He was treated for severe hyponatremia at 104 mmol/L by careful rehydration with saline before being transferred to a nephrological hospital. Magnetic resonance imaging (MRI) performed at D14 for locked-in syndrome showed osmotic demyelination syndrome (Figure 1). The evolution was favorable after 3 months of rehabilitation marked by a progressive and clear improvement of clinical signs. Conclusion: This observation suggests an evaluation of the benefit/risk ratio of the short-term prognosis of profound hyponatremia with that of the metabolic stress induced by a still too rapid correction. Particular attention should be paid to diabetic patients in the context of chronic alcoholism or nutritional deficiencies.
Introduction: Centropontine myelinolysis (CPM) is a rare pathology, a delayed neurological complication corresponding to massive demyelination of the protrusion. Its exact pathogenesis is poorly understood. Rapid correction of sodium hyponatremia has been implicated as a potent causative factor. We report a case of CPM despite a priori conservative correction of hyponatremia with a favorable course in a 61-year-old alcoholic-smoker diabetic. Case Presentation: A 61-year-old man with chronic alcoholism presented to the emergency department (D0) with physical asthenia and anorexia. He was treated for severe hyponatremia at 104 mmol/L by careful rehydration with saline before being transferred to a nephrological hospital. Magnetic resonance imaging (MRI) performed at D14 for locked-in syndrome showed osmotic demyelination syndrome (Figure 1). The evolution was favorable after 3 months of rehabilitation marked by a progressive and clear improvement of clinical signs. Conclusion: This observation suggests an evaluation of the benefit/risk ratio of the short-term prognosis of profound hyponatremia with that of the metabolic stress induced by a still too rapid correction. Particular attention should be paid to diabetic patients in the context of chronic alcoholism or nutritional deficiencies.
作者
Aboubacar Sidiki Fofana
Magara Samaké
Sah dit Baba Coulibaly
Seydou Sy
Atabième Kodio
Moctar Coulibaly
Christophe Bouaka
Ghassan Alchahin
Hermione Deudjeu Youmbissie
Hamadoun Yattara
Nouhoum Coulibaly
Saharé Fongoro
Aboubacar Sidiki Fofana;Magara Samaké;Sah dit Baba Coulibaly;Seydou Sy;Atabième Kodio;Moctar Coulibaly;Christophe Bouaka;Ghassan Alchahin;Hermione Deudjeu Youmbissie;Hamadoun Yattara;Nouhoum Coulibaly;Saharé Fongoro(Nephrology Unit, Fousseyni Daou Hospital in Kayes, Kayes, Mali;National Center for Scientific and Technological Research (CNRST), Bamako, Mali;Nephrology Unit, Somino Dolo Hospital in Mopti, Mopti, Mali;Nephrology and Hemodialysis Department, University Teaching Hospital of Point-G, Bamako, Mali;Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali;Nephrology Unit, Mali Gavardo Hospital, Bamako, Mali;Nephrology and Hemodialysis Department, Martigues Hospital, Martigues, France;Medical Imaging Department, Martigues Hospital, Martigues, France)
