ABSTRACT
A 21-year-old woman underwent surgery for a pituitary tumor. On the 11th postoperative day, blood examination revealed severe hyponatremia, with a serum sodium level of 111â mEq/l, and two days later this increased rapidly to 137â mEq/l. On the 20th postoperative day, the patient developed dysarthria and gait disturbance. Head MRI on the 30th postoperative day demonstrated intense high-signal lesions in the pons and bilateral corpus striatum on FLAIR and DWI, and central pontine and extrapontine myelinolysis was diagnosed. The patient's symptoms improved gradually after rehabilitation and antispasticity treatment. It was suggested that the changes in serum sodium levels after pituitary surgery were due to impaired secretion of antidiuretic hormone due to degeneration of nerve terminals in the posterior pituitary. As pituitary surgery may trigger changes in serum sodium leading to myelinolysis, this possibility should always be borne in mind when treating such patients.
Subject(s)
Central Nervous System Cysts/surgery , Myelinolysis, Central Pontine/etiology , Pituitary Neoplasms/surgery , Postoperative Complications/etiology , Adult , Anticonvulsants/therapeutic use , Central Nervous System Cysts/complications , Female , Humans , Hyponatremia/etiology , Inappropriate ADH Syndrome/etiology , Magnetic Resonance Imaging , Myelinolysis, Central Pontine/diagnostic imaging , Myelinolysis, Central Pontine/diet therapy , Myelinolysis, Central Pontine/rehabilitation , Pituitary Neoplasms/complications , Postoperative Complications/diagnostic imaging , Postoperative Complications/drug therapy , Postoperative Complications/rehabilitation , Treatment Outcome , Young AdultABSTRACT
A 4-year-old boy presented with a history of tremor for 7 days. He also had recurrent diarrhea for the previous 1 year, and poor weight gain. Magnetic resonance of the brain was suggestive of central pontine myelinolysis. There was no evidence of electrolyte abnormalities. The serum tissue transglutaminase level was markedly elevated, and the duodenal biopsy revealed features of celiac disease. The patient was started on gluten-free diet. The tremor resolved within 3 months. Repeat imaging of the brain done 3 months after starting gluten-free diet showed complete resolution of the lesion. This case highlights the unusual presentation of central pontine myelinosis as tremor in a malnourished child with celiac disease.