PDF(Pubmed)
Abstract：
Hypernatremia (serum sodium>160 meq/L) present with diverse neurological manifestations, ranging from flaccid paralysis to impaired cognition, encephalopathy, and even deep coma. Osmotic demyelination refers to changes in brain cells because of an acute change in plasma osmolality. It is further divided into two types, i.e., central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM). Patients with EPM, besides spasticity, may also present with other movement disorders such as catatonia, parkinsonism, and dystonia. We present a case of a postpartum woman bought to the emergency department by her relatives in an unconscious state. In view of poor sensorium (Glasgow coma scale < 7), she was intubated and received mechanical ventilatory support. On admission, computed tomography ofthebrain was normal, and the patient was transferred to the intensive care unit (ICU) for further management. The preliminary work-up in the ICU showed hypernatremia (serum sodium of 182 mEq/L) with hyper-osmolality (359 mOsm/kgH2O). She was managed as per the ICU protocol for hypernatremia. During her ICU stay, her sensorium improved, but she developed flaccid paralysis and was quadriplegic. Thus, a tracheostomy was performed, and she was weaned from the ventilator. After ventilator weaning, she was transferred to the ward for further rehabilitation. During rehabilitation, the patient was able to sit and takefoodorally.To date, only a few cases are reported in postpartum women with acute severe hypernatremia caused by high-grade fever and loss of body fluids leading to extra-pontine demyelination and flaccid paralysis. This case highlightsthat prompt recognition and appropriate intervention can improve the outcomes in these patients.
摘要：
高钠血症（血清钠>160meq/L）存在不同的神经系统表现，从弛缓性麻痹到认知功能受损，脑病,甚至深度昏迷.渗透性脱髓鞘是指由于血浆渗透压的急性变化而引起的脑细胞变化。它进一步分为两种类型，即，脑桥中央髓鞘溶解(CPM)和脑桥外髓鞘溶解(EPM)。EPM患者,除了痉挛,也可能出现其他运动障碍，如紧张症，帕金森病,和肌张力障碍.我们介绍了一个产后妇女在昏迷状态下由亲戚向急诊科购买的案例。鉴于感觉良好（格拉斯哥昏迷评分<7），她接受了插管并接受了机械通气支持。一入场,大脑的计算机断层扫描是正常的，患者被转移到重症监护病房(ICU)接受进一步治疗.ICU的初步检查显示高钠血症（血清钠为182mEq/L），渗透压高（359mOsm/kgH2O）。她按照ICU高钠血症方案进行管理。在她住ICU期间，她的感觉改善了，但是她出现了弛缓性麻痹，四肢瘫痪。因此，做了气管切开术,她从呼吸机上断奶了.呼吸机断奶后,她被转移到病房接受进一步康复。康复期间,患者能够坐着吃东西。迄今为止,在产后妇女中，只有少数病例报告了由高热和体液流失导致的急性严重高钠血症，导致桥脑外脱髓鞘和弛缓性麻痹。这种情况突出表明，及时识别和适当的干预可以改善这些患者的预后。
