Moore K, Midha M
Spinal Cord Injury Service, Department of Veterans Affairs Medical Center, Richmond, Virginia, USA.
Spinal Cord. 1997 May;35(5):332-4. doi: 10.1038/sj.sc.3100371.
Hyposmolar hyponatremia (serum sodium < 130 mmol/l) is a common phenomenon in the spinal cord injury (SCI) patient population and in most cases, it is of relatively little consequence. However, rapid correction or over correction of hyponatremia (a change in serum sodium > 25 mmol/l within 48 h) has been linked to Central Pontine Myelinolysis (CPM) and Extra Pontine Myelinolysis (EPM), usually along with other recognized predisposing factors. We report the first case of isolated Extra Pontine Myelinolysis in an SCI patient without any of the recognized predisposing factors, following correction of hyponatremia. The signs and symptoms of Extra Pontine Myelinolysis were not very remarkable in our patient because of prior spinal cord injury. The diagnosis was confirmed by the typical finding of myelinolysis in the basal ganglion region on MRI. Hyponatremia occurs frequently in the SCI patient population, thus placing them at increased risk for Extra Pontine Myelinolysis. Therefore, we emphasize the importance of watching for this entity during the management of hyponatremia in the SCI patient population and recommend the use of MRI scans to confirm the clinical diagnosis.
低渗性低钠血症（血清钠<130 mmol/L）在脊髓损伤（SCI）患者群体中是一种常见现象，且在大多数情况下，后果相对较小。然而，低钠血症的快速纠正或过度纠正（48小时内血清钠变化>25 mmol/L）与中央桥脑髓鞘溶解症（CPM）和脑桥外髓鞘溶解症（EPM）有关，通常还伴有其他公认的易感因素。我们报告了首例在纠正低钠血症后，一名无任何公认易感因素的SCI患者发生孤立性脑桥外髓鞘溶解症的病例。由于先前存在脊髓损伤，脑桥外髓鞘溶解症的体征和症状在我们的患者中并不十分显著。通过MRI上基底节区典型的髓鞘溶解表现确诊。低钠血症在SCI患者群体中频繁发生，从而使他们发生脑桥外髓鞘溶解症的风险增加。因此，我们强调在管理SCI患者群体的低钠血症过程中警惕这一情况的重要性，并建议使用MRI扫描来确诊临床诊断。
