Tonelli J, Zurrú M C, Castillo J, Casado P, Di Prizito C, Gutfraind E
Departamento de Clínica Médica y de Neurología, Hospital Santojanni, Argentina.
Medicina (B Aires). 1999;59(2):176-8.
An 18-year-old woman in her first pregnancy with hyperemesis gravidarum, presented dehydration, without hyponatremia. She was confused with profound disorientation, apathy, and drowsiness. She presented upbeating nistagmus on upward gaze and gate ataxia recognised as Wernicke's encephalopathy. Laboratory tests demonstrated hypokalemia, hypernatremia and aminotransferase elevation. The serum osmolality was 319 mOsm/kg and the water deficiency 2.73 l. The patient developed weakness in the four limbs, with hypotonicity, absence of tendon reflexes and showed bilateral Babinski signs. A T2 weighted sagittal cranial-magnetic resonance imaging revealed a high signal within mid-pons suggesting central pontine myelinolysis. In this case we highlight the absence of hyponatremia. Furthermore, the central pontine myelinolysis was probably secondary to hypokalemia, hypernatremia and hyperosmolality.
一名18岁初孕女性,患有妊娠剧吐,出现脱水,但无低钠血症。她意识模糊,有严重的定向障碍、淡漠和嗜睡。向上凝视时出现上跳性眼球震颤,步态共济失调,被诊断为韦尼克脑病。实验室检查显示低钾血症、高钠血症和转氨酶升高。血清渗透压为319 mOsm/kg,缺水量为2.73升。患者出现四肢无力,伴有张力减退、腱反射消失,并出现双侧巴宾斯基征。T2加权矢状位头颅磁共振成像显示脑桥中部有高信号,提示为中央型脑桥髓鞘溶解症。在这种情况下,我们强调无低钠血症。此外,中央型脑桥髓鞘溶解症可能继发于低钾血症、高钠血症和高渗状态。