Department of Neurology, Goa Medical College, Bambolim, Goa 403 202, India.
J Clin Neurosci. 2011 Apr;18(4):587-9. doi: 10.1016/j.jocn.2010.08.001. Epub 2011 Jan 26.
Extrapontine myelinolysis in association with the more common central pontine variety is increasingly reported. Although typically associated with rapid correction of hyponatraemia, myelinolysis is also seen when sodium correction occurs at recommended rates. We present a 60-year-old man who developed hyponatraemia and hypokalaemia due to repeated vomiting. An acute symmetric akinetic-rigid syndrome followed correction of hyponatraemia, performed in line with current guidelines. There were no clinical features of pontine involvement even though a typical lesion was seen on MRI. Bilateral putaminal and caudate lesions were seen. He recovered well with only symptomatic treatment. Myelinolysis can present with features of extrapontine involvement with the pontine lesions remaining asymptomatic. Current guidelines for the correction of hyponatraemia do not prevent development of myelinolysis in all instances. In contrast to the generally expected poor outcome in this condition, patients do make a good recovery with symptomatic treatment and good nursing care.
外展神经脑桥髓鞘溶解症与更为常见的脑桥中央髓鞘溶解症一起越来越多地被报道。虽然髓鞘溶解症通常与低钠血症的快速纠正有关，但当钠按推荐速度纠正时也会发生髓鞘溶解症。我们介绍了一位 60 岁的男性，由于反复呕吐导致低钠血症和低钾血症。低钠血症纠正后出现急性对称的无动性僵硬综合征，符合当前指南。尽管 MRI 上可见典型病变，但没有桥脑受累的临床特征。双侧壳核和尾状核病变。他仅接受对症治疗后恢复良好。髓鞘溶解症可表现为外展神经受累的特征，而桥脑病变保持无症状。目前低钠血症纠正的指南并不能预防所有情况下髓鞘溶解症的发生。与这种情况通常预期的不良预后相反，患者在接受对症治疗和良好护理后会很好地恢复。
