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Journal of Intensive Care Medicine, Vol. 21, No. 6, 372-376 (2006)
DOI: 10.1177/0885066606293358
© 2006 SAGE Publications

Osmotic Demyelination and Hypertonic Dehydration in a 9-Year-Old Girl: Changes in Cerebrospinal Fluid Myelin Basic Protein

Bobby Shah, BS, BA

University of Missouri School of Medicine, Columbia, Missouri

Joseph D. Tobias, MD

Departments of Anesthesiology and Pediatrics, University of Missouri, Columbia, Missouri, Tobiasj{at}health.missouri.edu

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.

Key Words: hyponatremia • central pontine myelinolysis • myelin basic protein

References

  • Brown WD. Osmotic demyelination disorders: central pontine and extrapontine myelinolysis. Curr Opin Neurol. 2000;13: 691-697.[CrossRef][Medline] [Order article via Infotrieve]
  • Boon AP, Carey MP, Salmon MV. Central pontine myelinolysis not associated with rapid correction of hyponatremia [letter]. Lancet. 1998;2: 458-458.
  • Pfister HW, Einhauple KM, Brandt T. Mild central pontine myelinlolysis: a frequently undetected syndrome. Eur Arch Psychol Neurol Sci. 1985;235: 134-139.
  • Adams RD, Victor M, Mancall EL. Central pontine myelinolysis: a hitherto underdescribed disease occurring in alcoholic and malnourished patients. Arch Neurol Psychol. 1959;81: 154-172.
  • DeLuca GC, Nagy ZS, Esiri MM, Davey P. Evidence for a role for apoptosis in central pontine myelinolysis. Acta Neuropathol. 2002;103: 590-598.[CrossRef][Medline] [Order article via Infotrieve]
  • Laureno R, Illowsky B. Update: Myelinolysis after correction of hyponatremia. Ann Intern Med. 1997;126: 57-62.[Abstract/Free Full Text]
  • Lien YH, Shapiro JL, Chan L. Study of brain electrolytes and organic osmolytes during correction of chronic hyponatremia. Implications for the pathogenesis of central pontine myelinolysis. J Clin Invest. 1991;88: 303-309.[Medline] [Order article via Infotrieve]
  • Sugimote T, Murata T, Omori M, Wada Y. Central pontine myelinolysis associated with hypokalemia in anorexia nervosa. J Neurol Neurosurg Psychol. 2003;74: 353-355.[Abstract/Free Full Text]
  • Pirzada NA, Ali II. Central pontine myelinolysis. Mayo Clinic Proc. 2001;6: 559-562.
  • Niehaus L, Kulozik A, Lehmann R. Reversible central pontine and extrapontine myelinolysis in a 16-year-old girl. Childs Nerv Syst. 2001;17: 294-296.[CrossRef][Medline] [Order article via Infotrieve]
  • Menger H, Jorg J. Outcomes of central pontine and extrapontine myelinlolysis. J Neurol. 1999;246: 700-705.[CrossRef][Medline] [Order article via Infotrieve]
  • Ruzek KA, Norbert GC, Miller GM. Early diagnosis of central pontine myelinolysis with diffusion-weighted imaging. Am J Neuroradiol. 2004;25: 210-213.[Abstract/Free Full Text]
  • Menakaya J, Wassmer E, Bradshaw K, Seri S, Whitehouse W. Idiopathic central pontine myelinolysis in childhood. Dev Med Child Neurol. 2001;43: 697-700.[CrossRef][Medline] [Order article via Infotrieve]
  • McGraw P, Edwards-Brown M. Reversal of MR findings of central pontine myelinolysis. J Comput Assist Tomogr. 1998; 22: 989-991.[CrossRef][Medline] [Order article via Infotrieve]
  • Aydin O, Senbil N, Bek K, Erdogan O, Gurer Y. Central pontine and extrapontine myelinolysis owing to disequilibrium syndrome. J Child Neurol. 2003;18: 292-296.[Abstract/Free Full Text]
  • Tarhan N, Firat A, Otken A, Agildere A, Demirceken F. Central pontine myelinolysis secondary to cytomegalovirus hepatitis in a 10-month-old child. Pediatr Radiol. 2003;33: 44-46.[CrossRef][Medline] [Order article via Infotrieve]
  • Udani V, Dharnidharka V, Gajendragadkar A, D’Souza B. Extra and central pontine myelinolysis in a child with adrenal insufficiency. Pediatr Neurol. 1997;17: 158-160.[CrossRef][Medline] [Order article via Infotrieve]
  • Choksi R, Roach E. Ring-enhancing lesion in central pontine myelinolysis. Arch Neurol. 2005;62: 1016-1016.[Free Full Text]
  • Nagamitsu S, Matsuishi T, Yamashita Y, et al. Extrapontine myelinolysis with parkinsonism after rapid correction of hyponatremia: high cerebrospinal fluid level of homovanillic acid and successful dopaminergic treatment. J Neural Transm. 1999;106: 949-953.[CrossRef][Medline] [Order article via Infotrieve]
  • Choe W, Cho B-K, Kim I, Shin H, Wang K-C. Extrapontine myelinolysis caused by electrolyte imbalance during the management of suprasellar germ tumors. Childs Nerv Syst. 1998;14: 155-158.[CrossRef][Medline] [Order article via Infotrieve]
  • Gregorio L, Sutton SL, Lee DA. Central pontine myelinolysis in a previously healthy 4-year-old child with acute rotavirus gastroenteritis. Pediatrics. 1997;99: 738-743.[Free Full Text]
  • Brown WD, Caruso JM. Extrapontine myelinolysis with involvement of the hippocampus in three children with severe hypernatremia. J Child Neurol. 1999;14: 428-433.[Abstract/Free Full Text]
  • Haspolat S, Duman O, Senol U, et al. Extrapontine myelinolysis in infancy: report of a case. J Child Neurol. 2004;19: 913-915.[Medline] [Order article via Infotrieve]
  • Ramaekers VT, Reul J, Kusenback G, et al. Central pontine myelinolysis associated with acquired folate deficiency. Neuropediatrics. 1997;28: 126-130.[Medline] [Order article via Infotrieve]
  • Bonkowsky JL, Filloux FM. Extrapontine myelinolysis in a pediatric case of diabetic ketoacidosis and cerebral edema. J Child Neurol. 2003;18: 144-147.[Abstract/Free Full Text]
  • Oya S, Tsutsumi K, Ueki K, Kirino T. Reinduction of hyponatremia to treat central pontine myelinolysis. Neurology. 2000;57: 1931-1932.
  • Bibl D, Lampl C, Gabriel C, Jüngling G, Brock H, Köstler G. Treatment of central pontine myelinolysis with therapeutic plasmapheresis. Lancet. 1999;353: 1159-1162.
  • 28, Grimaldi D, Cavalleri F, Vallone S, Milanti G, Cortelli P. Plasmapheresis improves the outcome of central pontine myelinolysis. J Neurol. 2005;252: 734-735.[CrossRef][Medline] [Order article via Infotrieve]
  • Karp BI, Laureno R. Pontine and extrapontine myelinolysis: a neurologic disorder following rapid correction of hyponatremia. Medicine. 1993;72: 359-373.[Medline] [Order article via Infotrieve]
  • Harauz G, Ishiyama N, Hill C, Bates I, Libich D, Fares C. Myelin basic protein-diverse conformational states of an intrinsically unstructured protein and its roles in myelin assembly and multiple sclerosis. Micron. 2004;35: 503-542.[CrossRef][Medline] [Order article via Infotrieve]
  • Lutton J, Winston R, Rodman T. Multiple sclerosis: etiological mechanisms and future directions. Exp Biol Med. 2004; 229: 12-20.[Abstract/Free Full Text]
  • Meinl E, Hohlfeld R. Immunopathogenesis of multiple sclerosis: MBP and beyond. Clin Exp Immunol. 2002;128: 395-397.[CrossRef][Medline] [Order article via Infotrieve]
  • Liuzzi G, Mastroianni C, Vullo V, Jirillo E, Delia S, Riccio P. Cerebrospinal fluid myelin basic protein as predictive marker of demyelination in AIDS dementia complex. J Neuroimmunol.1992; 36: 251-254.[CrossRef][Medline] [Order article via Infotrieve]

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This Article
Right arrow Abstract Freely available
Right arrow Free Full Text (Free PDF) Free
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Right arrow Articles by Shah, B.
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What's this?