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Campetella L, Villagrán-García M, Farina A, Benaiteau M, Iorio R, Calabresi P, Vogrig A, Versace S, Ciano-Petersen NL, Bicilli Brotelle E, Branger P, Verlut C, Langner-Lemercier S, Leclancher A, Duwicquet C, Charif M, Kerschen P, Capet N, Renard D, Chanson E, Rafiq M, Tyvaert L, Joubert B, Cotton F, Honnorat J, Muñiz-Castrillo S. Corticospinal tract hyperintensity in patients with LGI1-antibody encephalitis and other central nervous system disorders with neuroglial antibodies. J Neuroimmunol 2024; 390:578346. [PMID: 38648696 DOI: 10.1016/j.jneuroim.2024.578346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
The frequency of corticospinal tract (CST) T2/FLAIR hyperintensity in disorders with neuroglial antibodies is unclear. Herein, we retrospectively reviewed brain MRIs of 101 LGI1-antibody encephalitis patients, and observed CST hyperintensity in 30/101 (30%). It was mostly bilateral (93%), not associated with upper motor neuron signs/symptoms (7%), and frequently decreased over time (39%). In a systematic review including patients with other neuroglial antibodies, CST hyperintensity was reported in 110 with neuromyelitis optica (94%), myelin oligodendrocyte glycoprotein-associated disease (2%), Ma2-antibody (3%) and GAD65-antibody paraneoplastic neurological syndrome (1%). CST hyperintensity is not an infrequent finding in LGI1-Ab encephalitis and other disorders with neuroglial antibodies.
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Affiliation(s)
- Lucia Campetella
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69008 Lyon, France; Neuroscience Department, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Macarena Villagrán-García
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69008 Lyon, France
| | - Antonio Farina
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69008 Lyon, France; Department of Neuroscience, Psychology, Pharmacology and Child Health, University of Florence, Viale Gaetano Pieraccini 6, 50139 Florence, Italy
| | - Marie Benaiteau
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69008 Lyon, France
| | - Raffaele Iorio
- Neuroscience Department, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy; Clinical Neurology, Department of Ageing, Neurosciences, Head-neck and Orthopaedics Sciences, Fondazione Policlinico Universitario A. Gemelli, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Paolo Calabresi
- Neuroscience Department, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy; Clinical Neurology, Department of Ageing, Neurosciences, Head-neck and Orthopaedics Sciences, Fondazione Policlinico Universitario A. Gemelli, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Alberto Vogrig
- Clinical Neurology, Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; Department of Medicine (DAME), University of Udine, Piazzale Massimiliano Kolbe 4, 33100 Udine, Italy
| | - Salvatore Versace
- Clinical Neurology, Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; Department of Medicine (DAME), University of Udine, Piazzale Massimiliano Kolbe 4, 33100 Udine, Italy
| | - Nicolás Lundahl Ciano-Petersen
- Neurology Service, Regional University Hospital of Málaga, Av. de Carlos Haya 84, Bailén-Miraflores 29010, Málaga, Spain; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, C. Severo Ochoa 35, Campanillas, 29590 Málaga, Spain; Red Andaluza de Investigación Clínica y Traslacional en Neurología (NeuroRECA), Av. de Carlos Haya 84, Bailén-Miraflores, 29010 Málaga, Spain
| | - Elodie Bicilli Brotelle
- Neurology Department, Centre Hospitalier d'Avignon, 305A Rue Raoul Follereau, 84000 Avignon, France
| | - Pierre Branger
- Neurology Department, CHU de Caen Normandie, Av. de la Côte de Nacre CS 30001, 14000 Caen, France
| | - Clotilde Verlut
- Neurology Department, CHRU de Besançon, 3 Bd Alexandre Fleming, 25030 Besançon, Cedex, France
| | | | - Alexandre Leclancher
- Department of Clinical Neurophysiology, Amiens University Medical Center, 1 Rue du Professeur Christian Cabrol, 80000 Amiens, France
| | - Coline Duwicquet
- Neurology and Clinical Neurophisiology Department, CHU Bretonneau, 2 Bd Tonnellé, 37000 Tours, France
| | - Mahmoud Charif
- Neurology Department, Multiple Sclerosis Unit, CHU Montpellier, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Philippe Kerschen
- Neurology Department, Luxembourg Hospital Center, L 4 Rue Nicolas Ernest Barblé, 1210 Rollengergronn-Belair-Nord Luxembourg, Luxembourg
| | - Nicolas Capet
- Neurology Department, Princesse Grace Hospital Center, 1 Av. Pasteur, 98000, Monaco; CRCSEP, Neurologie Pasteur 2, CHU de Nice, and UMR2CA (URRIS), Université Côte d'Azur, 30 Voie Romaine, 06000 Nice, France
| | - Dimitri Renard
- Neurology Department, CHU de Nîmes, 4 Rue du Professeur Robert Debré, 30900 Nîmes, France
| | - Eve Chanson
- Neurology Department, Centre Hospitalier Universitaire Gabriel Montpied, 58 Rue Montalembert, 63000 Clermont-Ferrand, France
| | - Marie Rafiq
- Neurology Department, Hôpital Pierre Paul Riquet, CHU de Toulouse, 2 Rue Charles Viguerie, 31300 Toulouse, France
| | - Louise Tyvaert
- Neurology Department, University Hospital of Nancy, Lorraine University, 29 Av. du Maréchal de Lattre de Tassigny, 54000 Nancy, France
| | - Bastien Joubert
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69008 Lyon, France; Neurology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 165 Chem. du Grand Revoyet, 69495 Oullins-Pierre-Bénite, France
| | - François Cotton
- Radiology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 165 Chem. du Grand Revoyet, 69495 Oullins-EPierre-Bénite, France; CREATIS, INSERM U1044, CNRS UMR 5220, UCBL1, 43 Bd du 11 Novembre 1918, 69100 Villeurbanne, France
| | - Jérôme Honnorat
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69008 Lyon, France
| | - Sergio Muñiz-Castrillo
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69008 Lyon, France; Stanford Center for Sleep Sciences and Medicine, Stanford University, 3165 Porter Dr, Palo Alto, CA 94304, United States.
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Hayashi M, Ueda M, Hayashi K, Kawahara E, Azuma SI, Suzuki A, Nakaya Y, Asano R, Sato M, Miura T, Hayashi H, Hayashi K, Kobayashi Y. Case report: Clinically mild encephalitis/encephalopathy with a reversible splenial lesion: an autopsy case. Front Neurol 2024; 14:1322302. [PMID: 38239318 PMCID: PMC10794512 DOI: 10.3389/fneur.2023.1322302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024] Open
Abstract
Clinically mild encephalitis/encephalopathy with a reversible splenial lesion is a clinicoradiological syndrome characterized by transient neuropsychiatric symptoms and hyperintensity of the splenium of the corpus callosum on diffusion-weighted MRI. Although intramyelinic edema and inflammatory cell infiltration can be predicted by MRI, the pathology of the splenium of the corpus callosum remains unknown. We encountered a case of clinically mild encephalitis/encephalopathy with a reversible splenial lesion and hypoglycemia in a patient who died of sepsis, and an autopsy was performed. The postmortem pathological findings included intramyelinic edema, myelin pallor, loss of fibrous astrocytes, microglial reactions, and minimal lymphocytic infiltration in the parenchyma. Based on these findings, transient demyelination following cytotoxic edema in the splenium of corpus callosum was strongly considered a pathogenesis of "clinically mild encephalitis/encephalopathy with a reversible splenial lesion" associated with hypoglycemia, and it could be generalized for the disease associated with the other causes. As cytotoxic edema could be the central pathology of the disease, the recently proposed term cytotoxic lesions of the corpus callosum may be applicable to this syndrome.
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Affiliation(s)
- Maho Hayashi
- Department of Diabetes and Endocrinology, Fukui General Hospital, Egami-cho, Fukui, Japan
| | - Midori Ueda
- Department of Rehabilitation Medicine, Fukui General Hospital, Egami-cho, Fukui, Japan
| | - Koji Hayashi
- Department of Rehabilitation Medicine, Fukui General Hospital, Egami-cho, Fukui, Japan
| | - Ei Kawahara
- Department of Pathology, Fukui General Hospital, Egami-cho, Fukui, Japan
| | - Shin-ichiro Azuma
- Department of Diabetes and Endocrinology, Fukui General Hospital, Egami-cho, Fukui, Japan
| | - Asuka Suzuki
- Department of Rehabilitation Medicine, Fukui General Hospital, Egami-cho, Fukui, Japan
| | - Yuka Nakaya
- Department of Rehabilitation Medicine, Fukui General Hospital, Egami-cho, Fukui, Japan
| | - Rei Asano
- Department of Rehabilitation Medicine, Fukui General Hospital, Egami-cho, Fukui, Japan
| | - Mamiko Sato
- Department of Rehabilitation Medicine, Fukui General Hospital, Egami-cho, Fukui, Japan
| | - Toyoaki Miura
- Department of Rehabilitation Medicine, Fukui General Hospital, Egami-cho, Fukui, Japan
| | - Hiromi Hayashi
- Department of Rehabilitation Medicine, Fukui General Hospital, Egami-cho, Fukui, Japan
| | - Kouji Hayashi
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, Egami-cho, Fukui, Japan
| | - Yasutaka Kobayashi
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, Egami-cho, Fukui, Japan
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3
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Imaging of metabolic and overload disorders in tissues and organs. Jpn J Radiol 2023; 41:571-595. [PMID: 36680702 DOI: 10.1007/s11604-022-01379-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/24/2022] [Indexed: 01/22/2023]
Abstract
Metabolic and overload disorders are a heterogeneous group of relatively uncommon but important diseases. While imaging plays a key role in the early detection and accurate diagnosis in specific organs with a pivotal role in several metabolic pathways, most of these diseases affect different tissues as part of a systemic syndromes. Moreover, since the symptoms are often vague and phenotypes similar, imaging alterations can present as incidental findings, which must be recognized and interpreted in the light of further biochemical and histological investigations. Among imaging modalities, MRI allows, thanks to its multiparametric properties, to obtain numerous information on tissue composition, but many metabolic and accumulation alterations require a multimodal evaluation, possibly using advanced imaging techniques and sequences, not only for the detection but also for accurate characterization and quantification. The purpose of this review is to describe the different alterations resulting from metabolic and overload pathologies in organs and tissues throughout the body, with particular reference to imaging findings.
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4
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Ghosh R, Dutta S, Ghosh M, Benito-León J. ‘Wine Glass’ sign following COVID-19 vaccination in a previously healthy adult. Neurologia 2022; 37:820-823. [PMID: 35136277 PMCID: PMC8813636 DOI: 10.1016/j.nrl.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- R Ghosh
- Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - S Dutta
- Department of Radiodiagnostic, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - M Ghosh
- Department of Radiodiagnostic, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - J Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
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5
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Ghosh R, Dutta S, Ghosh M, Benito-León J. 'Wine Glass' sign following COVID-19 vaccination in a previously healthy adult. Neurologia 2022; 37:820-823. [PMID: 36468431 PMCID: PMC9609644 DOI: 10.1016/j.nrleng.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/22/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- R. Ghosh
- Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - S. Dutta
- Department of Radiodiagnostic, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - M. Ghosh
- Department of Radiodiagnostic, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - J. Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain,Department of Medicine, Complutense University, Madrid, Spain,Corresponding author
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6
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Jeon SJ, Choi SS, Kim HY, Yu IK. Acute Acquired Metabolic Encephalopathy Based on Diffusion MRI. Korean J Radiol 2021; 22:2034-2051. [PMID: 34564957 PMCID: PMC8628163 DOI: 10.3348/kjr.2019.0303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/02/2020] [Accepted: 11/20/2020] [Indexed: 11/22/2022] Open
Abstract
Metabolic encephalopathy is a critical condition that can be challenging to diagnose. Imaging provides early clues to confirm clinical suspicions and plays an important role in the diagnosis, assessment of the response to therapy, and prognosis prediction. Diffusion-weighted imaging is a sensitive technique used to evaluate metabolic encephalopathy at an early stage. Metabolic encephalopathies often involve the deep regions of the gray matter because they have high energy requirements and are susceptible to metabolic disturbances. Understanding the imaging patterns of various metabolic encephalopathies can help narrow the differential diagnosis and improve the prognosis of patients by initiating proper treatment regimen early.
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Affiliation(s)
- Se Jeong Jeon
- Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - See Sung Choi
- Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - Ha Yon Kim
- Department of Radiology, Eulji University Hospital, Deajeon, Korea
| | - In Kyu Yu
- Department of Radiology, Eulji University Hospital, Deajeon, Korea.
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7
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Narayan A, Arora U, Garg P, Sethi P, Kumar A, Wig N. 'Locked-in' despite slow treatment: pontine and extrapontine demyelination in hypernatraemic encephalopathy. Intern Med J 2021; 51:1545-1546. [PMID: 34541764 DOI: 10.1111/imj.15475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ananthu Narayan
- Department of Medicine, All India Institute of Medical Sciences, Delhi, India
| | - Umang Arora
- Department of Medicine, All India Institute of Medical Sciences, Delhi, India
| | - Prerna Garg
- Department of Medicine, All India Institute of Medical Sciences, Delhi, India
| | - Prayas Sethi
- Department of Medicine, All India Institute of Medical Sciences, Delhi, India
| | - Arvind Kumar
- Department of Medicine, All India Institute of Medical Sciences, Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, Delhi, India
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8
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Manjubashini D, Nagarajan K, Amuthabarathi M, Papa D, Wadwekar V, Narayan SK. Magnetic Resonance Imaging in Peripartum Encephalopathy: A Pictorial Review. J Neurosci Rural Pract 2021; 12:402-409. [PMID: 33927531 PMCID: PMC8064849 DOI: 10.1055/s-0041-1727300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Acute neurological problems are significant disorders of pre- and postpartum period in women. We analyzed the magnetic resonance imaging (MRI) profile of patients presenting with peripartum encephalopathy over 2 years. Of 51 patients, MRI was abnormal in 40 patients and normal in 11 patients. Posterior reversible encephalopathy (13/40), cerebral venous thrombosis (6/40), and postpartum angiopathy (3/40) are the three most common causes of peripartum encephalopathy as identified in MRI. The other less common but important etiology include HELLP (Hemolysis, Elevated Liver enzymes and Low Platelet) syndrome (2), osmotic demyelination (2), antiphospholipid syndrome (2), tubercular meningitis/cerebritis (3), pituitary hyperplasia with hemorrhage (2), postictal edema (2), cerebellitis (1), transient splenial lesion (1), and changes of old trauma and stroke (one each).
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Affiliation(s)
- Duraipandi Manjubashini
- Department of Radio diagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) Puducherry, India
| | - Krishnan Nagarajan
- Department of Radio diagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) Puducherry, India
| | - Mohan Amuthabarathi
- Department of Radio diagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) Puducherry, India
| | - Dasari Papa
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) Puducherry, India
| | - Vaibhav Wadwekar
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) Puducherry, India
| | - Sunil K Narayan
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) Puducherry, India
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9
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Haghighi-Morad M, Naseri Z, Jamshidi N, Hassanian-Moghaddam H, Zamani N, Ahmad-Molaei L. Methadone-induced encephalopathy: a case series and literature review. BMC Med Imaging 2020; 20:6. [PMID: 31952488 PMCID: PMC6969410 DOI: 10.1186/s12880-020-0410-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/03/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Accidental ingestion or consumption of supra-therapeutic doses of methadone can result in neurological sequelae in humans. We aimed to determine the neurological deficits of methadone-poisoned patients admitted to a referral poisoning hospital using brain magnetic resonance (MR) and diffusion weighted (DW) imaging. METHODS In this retrospective study, brain MRIs of the patients admitted to our referral center due to methadone intoxication were reviewed. Methadone intoxication was confirmed based on history, congruent clinical presentation, and confirmatory urine analysis. Each patient had an MRI with Echo planar T1, T2, FLAIR, and DWI and apparent deficient coefficient (ADC) sequences without contrast media. Abnormalities were recorded and categorized based on their anatomic location and sequence. RESULTS Ten patients with abnormal MRI findings were identified. Eight had acute- and two had delayed-onset encephalopathy. Imaging findings included bilateral confluent or patchy T2 and FLAIR high signal intensity in cerebral white matter, cerebellar involvement, and bilateral occipito-parietal cortex diffusion restriction in DWI. Internal capsule involvement was identified in two patients while abnormality in globus pallidus and head of caudate nuclei were reported in another. Bilateral cerebral symmetrical confluent white matter signal abnormality with sparing of subcortical U-fibers on T2 and FLAIR sequences were observed in both patients with delayed-onset encephalopathy. CONCLUSIONS Acute- and delayed-onset encephalopathies are two rare adverse events detected in methadone-intoxicated patients. Brain MRI findings can be helpful in detection of methadone-induced encephalopathy.
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Affiliation(s)
- Maryam Haghighi-Morad
- Department of Radiology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Naseri
- Department of Radiology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazila Jamshidi
- Drug Health Services, Sydney Local Health District, Sydney, NSW, Australia
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Ahmad-Molaei
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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10
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Chhabra A, Kaushik R, Kaushik RM, Goel D. Extra-pontine myelinolysis secondary to hypernatremia induced by postpartum water restriction. Neuroradiol J 2017; 30:84-87. [PMID: 28059675 DOI: 10.1177/1971400916678246] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A young adult female with restricted water intake during the postpartum period presented with history of progressive weakness, dizziness and tendency to fall with generalized slowing of movement. On examination, patient was anaemic, febrile and stuporous. Investigations revealed hypernatremia, delta waves in electroencephalogram (EEG) and features suggestive of extra-pontine myelinolysis on magnetic resonance imaging (MRI) of brain. After correcting hypernatremia and instituting anti-cholinergic therapy, there was a gradual but steady improvement in neurological symptoms of the patient over a period of one week and the patient was discharged in a conscious, oriented and ambulant state. As such, neuroimaging findings can be crucial in diagnosing hypernatremic encephalopathy in the postpartum period.
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Affiliation(s)
- A Chhabra
- 1 Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - R Kaushik
- 1 Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - R M Kaushik
- 1 Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - D Goel
- 2 Neurology Department, Max Superspeciality Hospital, Dehradun, India
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11
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Chavadi CV, Suprasanna K, Dudekula A, Hegde M, Kory S. Wine Glass Sign and Empty Delta Sign: A Rare Imaging Presentation of Postpartum Encephalopathy in Dehydration. J Clin Diagn Res 2016; 10:TD01-2. [PMID: 27504377 DOI: 10.7860/jcdr/2016/16969.7903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/18/2016] [Indexed: 11/24/2022]
Abstract
Rapid correction of hyponatremia is a well-known cause of central pontine and extrapontine myelinolysis. But uncommonly seen and rarely reported in Hypernatraemia. We report a rare case presenting as postpartum psychosis, wherein imaging revealed myelinolysis of corticospinal tracts in wine glass distribution and empty delta sign due to cortical venous thrombosis. At follow-up 3 months later, revealed significant neurological improvement. Concurrance occurrence of this dual pathology is not been described, which in our case was due to high serum sodium levels at presentation and dehydration.
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Affiliation(s)
- Chanabasappa V Chavadi
- Assistant Professor, Department of Radiology, Kasturba Medical College, Manipal University , Mangalore, Karnataka, India
| | - K Suprasanna
- Assistant Professor, Department of Radiology, Kasturba Medical College, Manipal University , Mangalore, Karnataka, India
| | - Anees Dudekula
- Resident, Department of Radiology, Kasturba Medical College, Manipal University , Mangalore, Karnataka, India
| | - Madhav Hegde
- Associate Professor, Department Radiology, Dr. B.R. Ambedkar Medical College , Bengaluru, Karnataka, India
| | - Swetha Kory
- Resident, Department of Pathology, Yenepoya Medical College , Mangalore, Karnataka, India
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12
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Bhatia S, Kapoor AK, Sharma A, Gupta R, Kataria S. Cerebral encephalopathy with extrapontine myelinolysis in a case of postpartum hypernatremia. Indian J Radiol Imaging 2014; 24:57-60. [PMID: 24851006 PMCID: PMC4028916 DOI: 10.4103/0971-3026.130697] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Extrapontine myelinolysis, a fairly common metabolic disorder, is associated with neurological complications. Central pontine and extrapontine myelinolysis are commonly recognized with rapid correction of sodium. Myelinolysis, however, has rarely been described with hypernatremia. We report a rare case of post-partum hypernatremic encephalopathy associated with serum sodium levels as high as 200 mEq/l on presentation. Although the serum sodium levels were brought down gradually, subsequent imaging showed progression of demyelination and deterioration of the neurological status.
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Affiliation(s)
- Sonia Bhatia
- Department of Radiology, Medanta-The Medicity Hospital, Gurgaon, Haryana, India
| | - Abhay Kumar Kapoor
- Department of Radiology, Medanta-The Medicity Hospital, Gurgaon, Haryana, India
| | - Anurag Sharma
- Department of Internal Medicine, Medanta-The Medicity Hospital, Gurgaon, Haryana, India
| | - Rajiv Gupta
- Department of Radiology, Medanta-The Medicity Hospital, Gurgaon, Haryana, India
| | - Sushila Kataria
- Department of Internal Medicine, Medanta-The Medicity Hospital, Gurgaon, Haryana, India
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