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Bansal LR, Zinkus T. Osmotic Demyelination Syndrome in Children. Pediatr Neurol 2019; 97:12-17. [PMID: 31128892 DOI: 10.1016/j.pediatrneurol.2019.03.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 03/09/2019] [Accepted: 03/20/2019] [Indexed: 11/28/2022]
Abstract
Osmotic demyelination syndrome is an acute demyelination process that usually occurs several days following an osmotic stress. This syndrome is rare in adults (0.4% to 0.56%) and even more uncommon in children. We performed a review of all reported pediatric osmotic demyelination syndrome patients from 1960 to 2018. Among all 106 cases, 49 presented with isolated central pontine myelinolysis, 30 with isolated extrapontine myelinolysis, and 27 with combined central pontine myelinolysis and extrapontine myelinolysis. There was no gender preponderance, and the highest prevalence was noted between the ages one and five years. Magnetic resonance imaging remains the diagnostic modality of choice, and diffusion tensor imaging is now increasingly used for prognostication in osmotic demyelination syndrome. Sixty percent of the children had a complete neurological recovery. Current management of osmotic demyelination syndrome in children consists of supportive medical care, steroids, and intravenous immunoglobulin. Our review of the literature supports the hypothesis that steroids and immunoglobulins are potentially helpful, although additional controlled studies are needed.
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Affiliation(s)
- Lalit R Bansal
- Division of Neurology, Children's Mercy Hospital, Kansas City, Missouri.
| | - Timothy Zinkus
- Department of Radiology, Children's Mercy Hospital, Kansas City, Missouri
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2
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Extrapontine Myelinolysis and Reversible Parkinsonism After Hyponatremia Correction in a Case of Pituitary Adenoma: Hypopituitarism as a Predisposition for Osmotic Demyelination. World Neurosurg 2018; 118:304-310. [DOI: 10.1016/j.wneu.2018.07.115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 11/20/2022]
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3
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Coça KL, Bergmann A, Ferman S, Portela LN, Ribeiro MG. Achados de fala, deglutição e qualidade de vida na mielinólise extrapontina: relato de caso de uma adolescente com germinoma do sistema nervoso central. REVISTA CEFAC 2017. [DOI: 10.1590/1982-0216201719112116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO O presente trabalho é um relato de caso que descreve os achados fonoaudiológicos e de qualidade de vida apresentados por uma adolescente com um tumor do sistema nervoso central acometida pela mielinólise extrapontina. A mielinólise extrapontina é uma doença desmielinizante aguda que pode ser causada por variações abruptas na osmolaridade sérica, como o que ocorre na rápida correção da hiponatremia. Os dados foram obtidos a partir da avaliação clínica fonoaudiológica, de questionários pediátricos sobre a qualidade de vida e dados contidos no prontuário médico. A paciente apresentou mutismo, disartria e disfagia decorrentes da mielinólise extrapontina, com impactos significativos na sua comunicação verbal, alimentação e qualidade de vida. Os escores de qualidade de vida após a mielinólise extrapontina apresentaram piora quando comparados aos do período anterior à doença. Recebeu atendimento fonoaudiológico hospitalar e ambulatorial. Foram observadas evoluções nos padrões de fala, deglutição e mobilidade das estruturas orofaciais, com reversão parcial dos déficits neurológicos. A atuação fonoaudiológica, como parte de uma equipe multiprofissional de saúde, é de grande importância na reabilitação funcional dos pacientes acometidos por esta doença.
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Affiliation(s)
| | - Anke Bergmann
- Instituto Nacional de Câncer José de Alencar Gomes da Silva, Brazil
| | - Sima Ferman
- Instituto Nacional de Câncer José de Alencar Gomes da Silva, Brazil
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Shah B, Tobias JD. Osmotic Demyelination and Hypertonic Dehydration in a 9-Year-Old Girl: Changes in Cerebrospinal Fluid Myelin Basic Protein. J Intensive Care Med 2016; 21:372-6. [PMID: 17095502 DOI: 10.1177/0885066606293358] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A 9-year-old girl was admitted for the treatment of hyper-natremic dehydration. Her history was significant for psychogenic polydipsia, hyponatremia, and a renal concentrating defect. She presented with a 2-day history of altered mental status, ataxia, lethargy, fever, nausea, vomiting, and diarrhea. Meningitis was ruled out. Over the course of her illness, slow rehydration was maintained with a gradual decrease (10 mEq per 24 hours) of the serum sodium. Despite this care, she developed quadriparesis, and magnetic resonance imaging performed on day 6 of her illness was consistent with osmotic demyelination (central pontine myelinolysis). To rule out an excessively rapid correction of hypernatremia as the etiology of the problem, a myelin basic protein was measured in the cerebrospinal fluid that had been obtained on hospital day 1. The myelin basic protein was 649.50 ng/mL (normal, 0.07-4.10 ng/mL). The current literature is presented regarding the postulated pathogenesis of central pontine myelinolysis and suggested therapies, previous reports of central pontine myelinolysis in children are reviewed, and the potential role of myelin basic protein in its diagnosis is discussed.
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Affiliation(s)
- Bobby Shah
- University of Missouri School of Medicine, Columbia, MO 65212, USA
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Gencpinar P, Tekguc H, Senol AU, Duman O, Dursun O. Extrapontine myelinolysis in an 18-month-old boy with diabetic ketoacidosis: case report and literature review. J Child Neurol 2014; 29:1548-53. [PMID: 24563474 DOI: 10.1177/0883073813520496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Extrapontine myelinolysis is characterized by symmetric demyelination following rapid shifts in serum osmolality in the supratentorial compartment. Extrapontine myelinolysis in children is rare compared to adults. The most common underlying pathophysiology is rapid correction of hyponatremia. Only 2 cases were published after diabetic ketoacidosis without electrolyte imbalance in the English literature. This study presents an unusual and possibly the youngest case of extrapontine myelinolysis that occurred in the setting of diabetic ketoacidosis and complicated cerebral edema without electrolyte imbalance, along with a review of the literature.
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Affiliation(s)
- Pinar Gencpinar
- Department of Child Neurology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Hakan Tekguc
- Department of Pediatric Intensive Care, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - A Utku Senol
- Department of Radiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Ozgur Duman
- Department of Child Neurology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Oguz Dursun
- Department of Pediatric Intensive Care, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Sai Kiran NA, Mohan D, Sadashiva Rao A, Assis ZA, Thakar S, Hegde AS. Reversible extrapyramidal symptoms of extrapontine myelinolysis in a child following surgery for craniopharyngioma. Clin Neurol Neurosurg 2014; 116:96-8. [DOI: 10.1016/j.clineuro.2013.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 10/13/2013] [Accepted: 10/27/2013] [Indexed: 11/26/2022]
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7
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Extrapontine myelinolysis of osmotic demyelination syndrome in a case of postoperative suprasellar arachnoid cyst. Case Rep Med 2012; 2012:679257. [PMID: 23326275 PMCID: PMC3544276 DOI: 10.1155/2012/679257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 12/19/2012] [Indexed: 11/17/2022] Open
Abstract
The extrapontine myelinolysis of osmotic demyelination syndrome (ODS) is a well-known but uncommon disorder of the central nervous system. Although the mechanism is not fully understood and the treatment is controversial, hyponatremia is probably considered to be the main pathophysiological basis. There are few reports of ODS caused by a sellar lesion. Here we present a case of suprasellar arachnoid cyst that developed extrapontine myelinolysis of ODS after a neuroendoscopic treatment procedure. It is suggested that patients with suprasellar lesions are at risk of developing extrapontine myelinolysis of ODS and correction of hyponatremia in these cases should be closely monitored.
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Ranger AM, Chaudhary N, Avery M, Fraser D. Central pontine and extrapontine myelinolysis in children: a review of 76 patients. J Child Neurol 2012; 27:1027-37. [PMID: 22647485 DOI: 10.1177/0883073812445908] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to identify the causes and contributing factors, neurologic presentation, and outcomes of central pontine and extrapontine myelinolysis and to examine any trends in the presentation and course of these disorders over the past 50 years. Seventy-six pediatric cases were identified in the literature. Age, sex, decade of diagnosis, neurologic presentation, outcome, and attributed causes were extracted. The results showed that the diagnosis, course, and outcomes of central pontine and extrapontine myelinolysis clearly have changed over the past few decades. Early cases generally were diagnosed at autopsy as opposed to computed tomography or magnetic resonance imaging more recently. Ninety-four percent of cases prior to 1990 and only 7% of cases from 1990 onward resulted in patient mortality. The decade in which the case was reported was the strongest predictor of outcome (P < .001), followed by sodium dysregulation (P = .045) and dehydration (P = .07).
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Affiliation(s)
- Adrianna M Ranger
- Department of Clinical Neurological Sciences, Pediatric Neurosurgery, London, Ontario, Canada.
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9
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Central pontine and extrapontine myelinolysis associated with acute hepatic dysfunction. Neurol Sci 2011; 33:673-6. [DOI: 10.1007/s10072-011-0838-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 10/21/2011] [Indexed: 10/15/2022]
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TSUTSUMI S, YASUMOTO Y, ITO M. Central Pontine and Extrapontine Myelinolysis in an Infant Associated With the Treatment of Craniopharyngioma -Case Report-. Neurol Med Chir (Tokyo) 2008; 48:351-4. [DOI: 10.2176/nmc.48.351] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Satoshi TSUTSUMI
- Department of Neurological Surgery, Juntendo University Urayasu Hospital
| | - Yukimasa YASUMOTO
- Department of Neurological Surgery, Juntendo University Urayasu Hospital
| | - Masanori ITO
- Department of Neurological Surgery, Juntendo University Urayasu Hospital
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11
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Seok JI, Youn J, Chung EJ, Lee WY. Sequential observation of movement disorders and brain images in the case of central pontine myelinolysis and extrapontine myelinolysis. Parkinsonism Relat Disord 2006; 12:462-4. [PMID: 16731027 DOI: 10.1016/j.parkreldis.2006.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 02/02/2006] [Accepted: 02/03/2006] [Indexed: 11/29/2022]
Abstract
Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are well recognized syndromes related to rapid correction of hyponatremia and have been reported to show a variety of movement disorders. However, sequential observation of movement disorders as well as brain images has seldom been reported. We report a case of CPM and EPM presenting with various sequential changes in movement disorders including delayed choreic movement over 11 months; we present sequential brain magnetic resonance images showing increased T1 and decreased fat-suppression T1 signal intensity. We suggest that delayed low signal intensity, in the fat-suppression T1-weighted images, is a result of the destruction of myelin and by products. Damage to the myelin may cause various movement disorders in a delayed manner.
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Affiliation(s)
- Jung Im Seok
- Movement Disorder Division, Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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12
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Gonc EN, Kandemir N, Sen Y, Yordam N. Hyponatremia can be a presenting finding of multiple pituitary hormone deficiency in children: report of a case and review of literature. Clin Pediatr (Phila) 2005; 44:623-8. [PMID: 16151569 DOI: 10.1177/000992280504400711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E Nazli Gonc
- Hacettepe University Faculty of Medicine, Division of Pediatric Endocrinology, Ankara, Turkey
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13
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Bonkowsky JL, Filloux FM. Extrapontine myelinolysis in a pediatric case of diabetic ketoacidosis and cerebral edema. J Child Neurol 2003; 18:144-7. [PMID: 12693785 DOI: 10.1177/08830738030180021201] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Central pontine and extrapontine myelinolysis are characterized by symmetric demyelination following rapid shifts in serum osmolality, although in extrapontine myelinolysis, demyelination is confined to the supratentorial compartment. We present a case of extrapontine myelinolysis in a 17-year-old female that occurred in the setting of diabetic ketoacidosis, cerebral edema, mannitol therapy, and meningitis. The rate of correction of this patient's glucose and electrolyte levels was within well-accepted limits. Extrapontine myelinolysis is rare in pediatric patients: there are only 12 reports of extrapontine myelinolysis in children under age 20 years and no pediatric cases of extrapontine myelinolysis or central pontine myelinolysis associated with diabetic ketoacidosis. We review the published cases of extrapontine myelinolysis and examine the underlying etiologies and electrolyte disturbances that characterize these cases. This case expands the list of conditions in which extrapontine myelinolysis occurs to include pediatric patients with complicated diabetic ketoacidosis, emphasizing the importance of sudden osmolar shifts in the genesis of this disorder.
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Affiliation(s)
- Joshua L Bonkowsky
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City 84132, USA
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Kim DG, Kim HJ. The Department of Neurosurgery at Seoul National University: past, present, and future. Neurosurgery 2001; 48:919-28. [PMID: 11322453 DOI: 10.1097/00006123-200104000-00047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The Department of Neurosurgery at Seoul National University College of Medicine is one of the oldest neurosurgical departments in Korea, and it is a center of academic leadership in neurosurgery. In September 1957, the department was established by Bo Sung Sim, and it has produced many leaders of neurosurgery in Korea. Chairmen Bo Sung Sim, Kil Soo Choi, Dae Hee Han, and Byung-Kyu Cho each brought special skills and talents to the development of the department. The current and fifth chair, Hyun Jib Kim, assumed the chairmanship in July 2000. The department comprises 11 full-time faculty members, 5 fellows, and 14 residents. More than 1,700 neurosurgical procedures are performed annually in four operating theaters. A gamma knife was installed in 1997, and approximately 200 gamma knife procedures are performed each year. In addition to clinical activities, research and education for graduate and postgraduate students are also particular strengths of the department. This article traces the clinical, academic, and scientific development of the department, its present activities, and its future direction.
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Affiliation(s)
- D G Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Korea
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15
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Kim DG, Kim HJ. The Department of Neurosurgery at Seoul National University: Past, Present, and Future. Neurosurgery 2001. [DOI: 10.1227/00006123-200104000-00047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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16
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Cuvellier JC, Soto Ares G, de Sèze C, Santos C, Cuisset JM, Dhellemmes P, Vallée L. [Radiology case of the month. Extrapontine myelinolysis]. Arch Pediatr 2000; 7:75-7. [PMID: 10668090 DOI: 10.1016/s0929-693x(00)88921-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J C Cuvellier
- Service des malades infectieuses et de neurologie infantiles, CHRU, hôpital Roger-Salengro, Lille, France
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