REVIEWING AN EXCEPTIONAL INSTANCE OF EXTRAPONTINE MYELINOLYSIS POST HYPONATREMIA RECTIFICATION

Vidya Bhargav* and Mohammed Adil Mohammed Hilal*

ABSTRACT

Extrapontine myelinolysis, also known as osmotic demyelination syndrome, is a rare neurological disorder characterized by the destruction of myelin, the protective covering of nerve fibers, in regions outside the brainstem. This condition typically occurs as a complication of rapid correction of hyponatremia, independent of changes in serum sodium this will cause a rapid change in osmolarity of the extracellular compartments of the brain which lead to dehydration of energy depleted cells with subsequent axonal disfuguration in characteristic areas also[1] low sodium concentration in the blood, which can cause the body to lose or gain water too quickly. Hyponatremia is observed when serum sodium drops to less than 135mmol/L[2] What makes this condition different is the rate and the magnitude of correction of sodium. Over correction can lead to a severe irreversible damage and under correction hangs to potentially damaging clinical manifestations Value less than or in between 115-110mmol/L is considered severe carried with clinical manifestations as gait disturbances, hypoxia, slurring of speech, non cardiac pulmonary edema, increased intracranial pressure, seizures. The final treatment is also aided by the severity of symptoms.[3] Treatment consists of free water restriction and correction of the underlying condition. AVP (vasopressin) receptor antagonists (eg, conivaptan, tolvaptan). However, their mechanism of action poses a risk of overcorrection, as they lead to uncontrolled free water excretion hyponatremia being chronic and acute, chronic hyponatremia is more common. Treatment of chronic hyponatremia has been associated with the development of the osmotic demyelination syndrome (also known as central pontine myelinolysis). To minimize the risk newer guidelines recommend a maximum of 8 mEq/L in the first 24 hours, with a maximum of 6 mEq/L for patients at high risk rate.[4]

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