Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Korea.
Korean J Anesthesiol. 2010 Dec;59 Suppl(Suppl):S197-200. doi: 10.4097/kjae.2010.59.S.S197. Epub 2010 Dec 31.
Demyelination is characterized by the loss of myelin with the preservation of axons. Demyelinating diseases can be classified into several categories: demyelination due to inflammation, viral infection, osmotic derangements and hypoxic ischemia. In particular, osmotic myelinolysis is representative, and is associated with hyperosmolality, hypokalemia or rapid correction of hyponatremia. Osmotic myelinolysis was reported to be associated with underlying conditions, such as alcoholism, diuretics and malnutrition. A 67-year-old woman with hypertension was scheduled to undergo both total knee replacements (TKR). She was observed to be lethargic with dysphagia and quadriplegia after the second TKR. She had been taking diuretics for a long time, and did not have an adequate amount of food intake due to patient controlled analgesia and a gastric ulcer after the first TKR. A laboratory examination revealed hypokalemia but normonatremia. T2 weighted-MRI revealed abnormal high signal intensity in the basal ganglia and periventricular area. This case was diagnosed with osmotic myelinolysis associated with hypokalemia without an apparent sodium imbalance.
脱髓鞘的特征是髓鞘丢失，而轴突得以保留。脱髓鞘疾病可分为几类：由炎症、病毒感染、渗透紊乱和缺氧缺血引起的脱髓鞘。特别是，渗透性髓鞘溶解症具有代表性，与高渗血症、低钾血症或低钠血症的快速纠正有关。渗透性髓鞘溶解症与潜在疾病有关，如酒精中毒、利尿剂和营养不良。一名 67 岁患有高血压的女性计划同时进行双侧全膝关节置换术（TKR）。在第二次 TKR 后，她出现了嗜睡、吞咽困难和四肢瘫痪。她长期服用利尿剂，由于第一次 TKR 后患者自控镇痛和胃溃疡，她的食物摄入量不足。实验室检查显示低钾血症但血钠正常。T2 加权 MRI 显示基底节区和脑室周围区异常高信号强度。该病例诊断为低钾血症相关性渗透性髓鞘溶解症，无明显钠失衡。
