Ghoummid Zakaria, El Kaouri Mbark, Elkhayari Mina
Service d'Accueil des Urgences Vitales, Département d'Anesthésie Réanimation et Urgences, Hôpital Ibn Tofail, CHU Mohammed VI, Faculté de Médecine et de Pharmacie de Marrakech, Université Cadi Ayyad, Marrakech, Maroc.
Pan Afr Med J. 2019 Dec 20;34:208. doi: 10.11604/pamj.2019.34.208.19968. eCollection 2019.
Osmotic demyelination syndrome is characterized by the loss of myelin in the center of the basis pontis and other areas of the central nervous system. We report a case of osmotic demyelination syndrome in a 55-year-old female, with a past medical history of arterial hypertension and multi-level cervical spondylosis, hospitalized for acute altered mental status complicating an array of acute gastroenteritis, the patient was afebrile. The course was marked by neurologic aggravation with confusion, aphasia, tetraplegia and osteo-tendinous areflexia. Initial cerebral magnetic resonance imaging did not show any specific abnormalities. The diagnosis of Central pontine myelinolysis and extrapontine myelinolysis was confirmed by a cerebral magnetic resonance imaging done after 20 days of the first. The rapid correction of hyponatremia was the main cause of this syndrome, without neglecting the very likely role of the associated hypokalemia. The evolution of centropontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) is variable. The treatment is primarily preventive based on the careful correction of severe hyponatraemia and contributing factors.
渗透性脱髓鞘综合征的特征是脑桥基底部中央及中枢神经系统其他区域的髓鞘脱失。我们报告一例55岁女性的渗透性脱髓鞘综合征病例，该患者既往有动脉高血压和多节段颈椎病病史，因急性胃肠炎并发急性精神状态改变住院，患者无发热。病程以神经功能恶化、意识模糊、失语、四肢瘫和腱反射消失为特征。最初的脑部磁共振成像未显示任何特异性异常。首次检查20天后进行的脑部磁共振成像证实了中央脑桥髓鞘溶解症和脑桥外髓鞘溶解症的诊断。低钠血症的快速纠正为此综合征的主要病因，同时也不能忽视伴发的低钾血症可能起到的作用。中央脑桥髓鞘溶解症（CPM）和脑桥外髓鞘溶解症（EPM）的病情发展各不相同。治疗主要是预防性的，基于对严重低钠血症及相关因素的谨慎纠正。
