scholarly journals Selective Extrapontine Myelinolysis in Osmotic Demyelination Syndrome in a Case of Previously Undiagnosed Sheehan's Syndrome with Recurrent Hyponatraemia - A Rare Association

1970 ◽  
Vol 12 (1) ◽  
pp. 77-80
Author(s):  
FM Siddiqui ◽  
Md Mahmudur Rahman Siddiqui ◽  
Md Azharul Hoque ◽  
Saeedur Rahman Shujon ◽  
Ahmed Hossain
Keyword(s):  
Hospital Admissions ◽  
Marked Change ◽  
Osmotic Demyelination Syndrome ◽  
Sheehan’S Syndrome ◽  
Extrapontine Myelinolysis ◽  
Osmotic Demyelination ◽  
History Of ◽  
Sheehan's Syndrome ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain

Selective extrapontine myelinolysis (EPM) following a marked change in osmolarity, usually due to the rapid correction of hyponatraemia. Association of EPM in hyponatraemia from Sheehan's syndrome is very rare. We report a 38 years old lady with EPM, who presented with repeated attacks of hyponatraemia for 2 years, which were corrected several times after hospital admissions. She has got history of postpartum haemorrhage about 10 years back followed by secondary amenorrhoea and lactational failure. At present she came to us with features of parkinsonism, dystonia, mutism, insomnia and emotional outburst. Her magnetic resonance imaging (MRI) of the brain revealed features of myelinolysis with atrophied pituitary gland. Her serum pituitary hormonal levels confirm presence of hypopituitarism with secondary adrenal failure due to Sheehan's syndrome. Now her present features are due to selective extrapontine myelinolysis of osmotic demyelination, might be due to any episode of inappropriate intravenous correction of hyponatraemia. Keyword: Sheehan's syndrome; Hyponatraemia; Extrapontine myelinolysis; Osmotic demyelination syndrome DOI: 10.3329/jom.v12i1.6936J Medicine 2011; 12 : 77-80

scholarly journals Osmotic Demyelination Syndrome due to Rhabdomyolysis and Hyperosmolar Hyperglycemic Syndrome following Cardiogenic Shock

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Kosuke Katano ◽  
Nozomi Fuse ◽  
Yoshitaka Asano ◽  
Kimihiro Osada ◽  
Akira Miyabe ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Osmotic Demyelination Syndrome ◽  
Resonance Imaging ◽  
Impaired Consciousness ◽  
Central Nervous System Damage ◽  
Osmotic Demyelination ◽  
Disturbance Of Consciousness ◽  
Magnetic Resonance Imaging Mri ◽  
Hyperosmolar Hyperglycemic Syndrome ◽  
The Brain

Osmotic demyelination syndrome (ODS) is a relatively rare disease that causes rapid demyelination, resulting in pontine and central nervous system damage with various symptoms, including impaired consciousness. It often occurs when hyponatremia is rapidly corrected. However, it can also occur when a normonatremic patient suddenly develops hypernatremia. A 51-year-old man developed cardiogenic shock with impaired consciousness, hyperCKemia, hypernatremia, and hyperglycemia. Osmotic demyelination syndrome secondary to rhabdomyolysis and hyperosmolar hyperglycemic syndrome was suspected. The patient’s fluid volume decreased because of osmotic diuresis caused by hyperglycemia, and the blood sodium level increased rapidly. The latter resulted in ODS, which in turn resulted in a prolonged disturbance of consciousness, from which he has not yet recovered. ODS has been reported as a serious complication of rapid correction of hyponatremia, although it also occurs when normonatremia leads to hypernatremia. This disease is difficult to diagnose, as magnetic resonance imaging (MRI) of the brain is often unremarkable several weeks after its onset. This case of ODS occurred when normonatremia led to hypernatremia, as a result of rhabdomyolysis and hyperosmolar hyperglycemic syndrome. Diagnosis was made based on the MRI brain findings.

scholarly journals Diagnosing RCVS Without the CV

2015 ◽  
Vol 6 (3) ◽  
pp. NP1-NP4 ◽  
Author(s):  
Nuri Jacoby ◽  
Ulrike Kaunzner ◽  
Marc Dinkin ◽  
Joseph Safdieh
Keyword(s):  
Magnetic Resonance ◽  
Resonance Imaging ◽  
Multiple Risk Factors ◽  
Mri Brain ◽  
Cerebral Vasoconstriction ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy ◽  
Occipital Lobes ◽  
The Brain

This is a case of a 52-year-old man with a past medical history of 2 episodes of coital thunderclap headaches as well as recent cocaine, marijuana, and pseudoephedrine use, who presented with sudden, sharp, posterior headache associated with photophobia and phonophobia. His initial magnetic resonance imaging (MRI) of the brain, magnetic resonance angiography (MRA) of the head, and magnetic resonance venography (MRV) of the head were all normal as well as a normal lumbar puncture. Given the multiple risk factors for reversible cerebral vasoconstriction syndrome (RCVS), the patient was treated for suspected RCVS, despite the normal imaging. Repeat MRI brain 3 days after hospital admission demonstrated confluent white matter T2 hyperintensities most prominent in the occipital lobes, typical of posterior reversible encephalopathy syndrome (PRES). Repeat MRA of the head 1 day after discharge and 4 days after the abnormal MRI brain showed multisegment narrowing of multiple arteries. This case demonstrates that RCVS may present with PRES on MRI brain and also exemplifies the need to treat suspected RCVS even if imaging is normal, as abnormalities in both the MRI and the MRA may be delayed.

scholarly journals Idiopathic Hypertrophic Pachymeningitis Manifesting with Frontal Brain Edema

2001 ◽  
Vol 19 (3) ◽  
pp. 491-495
Author(s):  
Mário Emílio Teixeira Dourado Júnior ◽  
Ricardo Humberto de Miranda Félix ◽  
Marcos Dias Leão
Keyword(s):  
Dura Mater ◽  
Histopathological Study ◽  
Hypertrophic Pachymeningitis ◽  
Falx Cerebri ◽  
Additional Information ◽  
Frontal Brain ◽  
History Of ◽  
Cerebral Parenchyma ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain

Introduction. Hypertrophic pachymeningitis (HP) is a rare inflammatory disease that results in thickening of the dura mater. Atypically, it can progress to include the involvement of the cerebral parenchyma. Method. In this paper, we report the rare case of a 31-year-old man with a three-week history of headaches, seizures, impairments of cognitive function, and changes in behavior and mood. Magnetic resonance imaging (MRI) of the brain showed a thickening and an abnormal enhancement of the dura mater over the falx cerebri with extensions into the adjacent cranial base and with brain edemas in the frontal lobes. Histopathological study of meningeal and brain biopsies showed an inflammatory process that was compatible with HP. The results of an extensive laboratory investigation were unremarkable and did not provide additional information on the cause of the meningeal disease. The patient exhibited relapses despite immunosuppressive therapy. Conclusion. This case shows the challenges associated with the management of the disease and the importance of early diagnosis to avoid worsening of the condition and cerebral damage.

scholarly journals Disseminated Mycobacterium tuberculosis following renal transplant: A case report

Pneumologia ◽  
2021 ◽  
Vol 69 (3) ◽  
pp. 182-185
Author(s):  
Mahmoud Sadeghi-Haddad-Zavareh ◽  
Mohammad Reza Hasanjani Roushan ◽  
Zeinab Mohseni Afshar ◽  
Masomeh Bayani ◽  
Soheil Ebrahimpour ◽  
...  
Keyword(s):  
Case Report ◽  
Renal Transplant ◽  
Psoas Abscess ◽  
Miliary Tuberculosis ◽  
Caseous Necrosis ◽  
High Clinical Suspicion ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain ◽  
Current Report

Abstract Miliary tuberculosis (TB) presents a major challenge following a renal transplant in humans. In the current report, we described a patient with disseminated TB following renal transplantation. The article presents the case of a 38-year-old man who presented an 8-month history of fever, chills, sweating, low-back pain and significant weight loss. Chest radiography and computed tomography (CT) scan showed miliary nodules distributed in the two lungs. The transbronchial lung biopsy revealed a granulomatous reaction with caseous necrosis. Magnetic resonance imaging (MRI) of the brain found multiple tuberculomas. Also, MRI of the lumbosacral was indicative of a psoas abscess. Therefore, miliary pulmonary, cerebral and spinal TB was confirmed. The patient was started on an anti-TB regimen and paravertebral aspiration was also done. The patient’s condition improved considerably. In conclusion, this case report can remind us of the importance of maintaining a high clinical suspicion and performing a thorough workup to establish a timely diagnosis and treatment of miliary TB.

Recurrent hypoglycaemia and dilated cardiomyopathy: delayed presentation of Sheehan’s syndrome

2021 ◽  
Vol 14 (6) ◽  
pp. e242747
Author(s):  
Archita Makharia ◽  
Manoj Lakhotia ◽  
Vineet Tiwari ◽  
Kishan Gopal
Keyword(s):  
Dilated Cardiomyopathy ◽  
Clinical Manifestations ◽  
Diabetic Woman ◽  
Delayed Presentation ◽  
Sheehan’S Syndrome ◽  
Life Threatening ◽  
History Of ◽  
Sheehan's Syndrome ◽  
Ischaemic Necrosis ◽  
Recurrent Hypoglycaemia

Sheehan’s syndrome (SS) is ischaemic necrosis of the pituitary gland due to massive postpartum haemorrhage. The clinical manifestations may vary from subtle to life-threatening and may present immediately after delivery or many years later. We present a case history of a 58-year-old non-diabetic woman who had undetected SS and presented with two unusual manifestations, including recurrent hypoglycaemia and dilated cardiomyopathy 34 years after delivery. The dilated cardiomyopathy reversed partially after treatment.

Brain Abscess and Spinal Epidural Abscess

2019 ◽  
pp. 642-648
Author(s):  
Selby G. Chen
Keyword(s):  
Magnetic Resonance Imaging ◽  
Brain Abscess ◽  
Hospital Admissions ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Early Management ◽  
Brain Abscesses ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Epidural ◽  
The Brain

Two infections of the brain are relatively common. Patients with brain abscess are often critically ill and have a high mortality rate. The reported incidence of brain abscesses ranges from 0.4 to 0.9 per 100,000 people. In contrast, spinal epidural abscess (SEA), an infection of the epidural space, has increased in incidence from approximately 0.2 to 1.2 per 10,000 hospital admissions in the mid-1970s to a currently estimated 2.0 to 12.5 per 10,000 admissions. Both disorders are now more easily detected with magnetic resonance imaging (MRI), and this has improved early management, but clinical recognition is still a challenge for many physicians.

scholarly journals Sheehan’s Syndrome Revisited: Underlying Autoimmunity or Hypoperfusion?

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
José Gerardo González-González ◽  
Omar David Borjas-Almaguer ◽  
Alejandro Salcido-Montenegro ◽  
René Rodríguez-Guajardo ◽  
Anasofia Elizondo-Plazas ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Diagnostic Criteria ◽  
Postpartum Hemorrhage ◽  
Hypovolemic Shock ◽  
Sheehan’S Syndrome ◽  
History Of ◽  
Sheehan's Syndrome ◽  
Pituitary Antibodies

Sheehan’s syndrome remains a frequent obstetric complication with an uncertain pathophysiology. We aimed to assess the incidence of hypopituitarism (≥2 hormonal axis impairment) within the first six postchildbirth months and to determine the existence of anti-pituitary antibodies. From 2015 to 2017, adult pregnant women, who developed moderate to severe postpartum hemorrhage (PPH), were consecutively included in the study. Pituitary function was assessed 4 and 24 weeks after PPH. At the end of the study, anti-pituitary antibodies were assessed. Twenty women completed the study. Mean age was 26.35 (±5.83) years. The main etiology for severe PPH was uterine atony (65%) which resulted mostly in hypovolemic shock grades III-IV. Within the first four weeks after delivery, 95% of patients had at least one hormonal pituitary affected and 60% of the patients fulfilled diagnostic criteria for hypopituitarism. At the end of the study period, five patients (25%) were diagnosed with hypopituitarism (GH and cortisol axes affected). Anti-pituitary antibodies were negative in all patients. At 6 months follow-up, one in every four women with a history of moderate-to-severe PPH was found with asymptomatic nonautoimmune-mediated hypopituitarism. The role of autoimmunity in Sheehan’s syndrome remains uncertain. Further studies are needed to improve the remaining knowledge gaps.

scholarly journals Isolated Extrapontine Myelinolysis of Osmotic Demyelination Syndrome

2013 ◽  
Vol 114 (1) ◽  
pp. 35-38
Author(s):  
Ömer Yılmaz ◽  
H. H. Armağn ◽  
A. Turan ◽  
M. Duymuş
Keyword(s):  
Serum Sodium ◽  
Rare Case ◽  
Sodium Concentration ◽  
Osmotic Demyelination Syndrome ◽  
Osmotic Demyelination ◽  
Extracellular Compartment ◽  
Rapid Changes ◽  
The Brain ◽  
Current Report ◽  
Rapid Correction

The osmotic demyelination syndrome (ODS) has been identified as a complication of the rapid correction of hyponatremia for decades (King and Rosner, 2010). However, in recent years, a variety of other medical conditions have been associated with the development of ODS, independent of changes in serum sodium which cause a rapid changes in osmolality of the interstitial (extracellular) compartment of the brain leading to dehydration of energy-depleted cells with subsequent axonal damage that occurs in characteristic areas (King and Rosner, 2010). Slow correction of the serum sodium concentration and additional administration of corticosteroids seems to be a major prevention step in ODS patients. In the current report we aimed to share a rare case which we observed in our clinic.

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