Joseph Abia, Sayeed Tass, Patel Dev K, Aiyadurai Sanathan, Shahbaz Zainab, Mettela Sambasiva Rao, Garg Tulika, Gadde Rishika, Udoeyop Datiobong, Khan Aadil
Surgery, John F. Kennedy University School of Medicine, Illinois, USA.
Internal Medicine, Windsor University School of Medicine, Chicago, USA.
Cureus. 2023 Mar 6;15(3):e35816. doi: 10.7759/cureus.35816. eCollection 2023 Mar.
Aggressive treatment of hyper or hypoosmolar conditions can trigger osmotic demyelination syndrome. We describe the case of a 53-year-old male who began using carbamazepine to treat bipolar affective disorder and was later diagnosed with carbamazepine-induced syndrome of inappropriate antidiuretic hormone secretion. The patient's mental state gradually improved once the hyponatremia was corrected using 3% normal saline and supportive therapy. The patient presented to the outpatient clinic with confusion and altered sensorium. Brain computed tomography showed diffuse cerebral atrophy and periventricular ischemia demyelination alterations, and magnetic resonance imaging showed an enhanced section in the brainstem that included the pons, suggesting osmotic demyelination alterations. Ventilatory support and supportive therapy were initiated, and hyponatremia was rectified. Although the patient did well with the treatment, his prognosis was still dismal, so he was sent home with instructions to follow up.
积极治疗高渗或低渗状态可引发渗透性脱髓鞘综合征。我们描述了一名53岁男性的病例，该患者开始使用卡马西平治疗双相情感障碍，后来被诊断为卡马西平诱导的抗利尿激素分泌不当综合征。使用3%生理盐水和支持性治疗纠正低钠血症后，患者的精神状态逐渐改善。患者因意识模糊和感觉改变到门诊就诊。脑部计算机断层扫描显示弥漫性脑萎缩和脑室周围缺血性脱髓鞘改变，磁共振成像显示脑干包括脑桥的一个强化区域，提示渗透性脱髓鞘改变。开始进行通气支持和支持性治疗，并纠正了低钠血症。尽管患者治疗效果良好，但其预后仍然不佳，因此嘱其回家随访。
