[P3-201] Reversible Extrapontine Myelinolysis in a Child Following Surgery for Craniopharyngioma
[Background]:Isolated extrapontine myelinolysis (EPM), following surgery for suprasellar lesions, is extremely uncommon in children.
[Objective]: This study aimed to evaluate the etiology, clinical and cranial imaging characteristics, treatment and outcomes of a child with EPM following surgery for craniopharyngioma.
[Methods]: We reviewed medical history, clinical manifestations, laboratory and cranial imaging, clinical process of diagnosis and treatment of the patient. The patient was followed up for one and a half year.
[Results]: The patient had convulsion after the surgery for craniopharyngioma. Her serum sodium was found 106.11mmol/L which was corrected to 133 mmol/L in one day. Six days after the correction of hyponatremia the patient developed stiff limbs, hypertonia and subsequently developed unconsciousness, mute, necessitating nasal feeding support. Eight days after the onset of the disease, magnetic resonance imaging(MRI) showed symmetrical hyperintense lesions on FLAIR/T2 weighted MRI involving the putamen, head of caudate nucleus, while the pons and the rest of the brain were not involved.The patient was treated with immunoglobulins,glucocorticoid, trihexyphenidyl, clonazepamand so on. At the time of discharge, she had improved considerably. Six months after the discharge, she can live and study normally.Eeleven months after the discharger, a repeat MRI revealed complete resolution of the abnormal signal changes.
[Conclusion]: EPM is often caused by rapid correction of chronic hyponatremia. EPM commonly presents with movement disorders and mutism.It is characterized by symmetrical hyperintense lesions on FLAIR/T2 weighted MRI commonly involving the putamen, head of caudate nucleus.The lesions on MRI may appear 1 week after the onset of the disease.Therefore we should not rule out the disease even when the early MRI is normal. Neither the clinical condition nor the extent of lesions on MRI is predictive of the final outcome.There is no special treatment for the disease, while we should focus more on the prevention. Isolated EPM usually had favourable prognosis.
[Objective]: This study aimed to evaluate the etiology, clinical and cranial imaging characteristics, treatment and outcomes of a child with EPM following surgery for craniopharyngioma.
[Methods]: We reviewed medical history, clinical manifestations, laboratory and cranial imaging, clinical process of diagnosis and treatment of the patient. The patient was followed up for one and a half year.
[Results]: The patient had convulsion after the surgery for craniopharyngioma. Her serum sodium was found 106.11mmol/L which was corrected to 133 mmol/L in one day. Six days after the correction of hyponatremia the patient developed stiff limbs, hypertonia and subsequently developed unconsciousness, mute, necessitating nasal feeding support. Eight days after the onset of the disease, magnetic resonance imaging(MRI) showed symmetrical hyperintense lesions on FLAIR/T2 weighted MRI involving the putamen, head of caudate nucleus, while the pons and the rest of the brain were not involved.The patient was treated with immunoglobulins,glucocorticoid, trihexyphenidyl, clonazepamand so on. At the time of discharge, she had improved considerably. Six months after the discharge, she can live and study normally.Eeleven months after the discharger, a repeat MRI revealed complete resolution of the abnormal signal changes.
[Conclusion]: EPM is often caused by rapid correction of chronic hyponatremia. EPM commonly presents with movement disorders and mutism.It is characterized by symmetrical hyperintense lesions on FLAIR/T2 weighted MRI commonly involving the putamen, head of caudate nucleus.The lesions on MRI may appear 1 week after the onset of the disease.Therefore we should not rule out the disease even when the early MRI is normal. Neither the clinical condition nor the extent of lesions on MRI is predictive of the final outcome.There is no special treatment for the disease, while we should focus more on the prevention. Isolated EPM usually had favourable prognosis.