•  
  •  
 

Rehabilitation Practice and Science

Translated Title

腦下垂體腺瘤切除術後併發橋腦中心及橋腦外髓鞘溶解症：病例報告

Abstract

Central pontine myelinolysis(CPM) and extrapontine myelinolysis(EPM), sharing the same pathology, are the same disease, although different symptoms and signs developed according to different lesion sites. The etiology and pathogenesis of CPM/EPM remain unclear, meanwhile rapid correction of the serum sodium level for hyponatremic patient has proven to be one of the major causes of CPM/EPM. Therefore an appropriate correction of the sodium level could prevent the development of CPM/EPM. The incidence of hyponatremia after surgical removal of pituitary adenoma reported varies from 8.4% to 38.8%. Most patients with symptomatic hyponatremia after the surgery recovered without neurological deficits. Only three cases have been reported to have central pontine or extrapontine myelinolysis due to the rapid elevation of serum sodium level after initial management.Our report presents a case who, after surgical removal of pituitary adenoma, suffered from severe hyponatremia secondary to anterior hypopituitarism. Replacement of thyroxin and hydrocortisone was applied in addition to salt replacement. However, the serum sodium level elevated abruptly, resulting in central pontine and extrapontine myelinolysis with the clinical manifestation of psychiatric disorder and conscious disturbance, ophthalmoparesis, dysphagia, and quadreparesis. Since hypothyroidism and adrenal gland insufficiency resulted from anterior hypopituitarism were considered the main causative factors of hyponatremia in this case, certain hormone replacements should correct the sodium level. The supplementation of salt might produce additional sodium loading thus inappropriately increasing the sodium level. We conclude that hyponatremia should be treated with respect to certain underlying diseases. Cautiously correcting the sodium imbalance and frequently following-up with measurements of the serum sodium level during sodium replacement therapy are essential to preventing CPM/EPM and the related complications.

Language

Traditional Chinese

First Page

251

Last Page

260

Download

Share

COinS