RESUMO
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Assuntos
Humanos , Feminino , Criança , Disgerminoma/tratamento farmacológico , Disgerminoma , Embolia e Trombose Intracraniana , Trombose Intracraniana/tratamento farmacológico , Trombose Intracraniana , Tomografia Computadorizada de Emissão/métodos , Cefaleia/complicações , Cefaleia/etiologia , Trombose Venosa/complicações , Fatores de Risco , Paresia/complicações , Papiledema/complicações , EcoencefalografiaRESUMO
Introducción. La mielinolisis central pontina (MCP) esuna alteración neurológica, de etiología desconocida, que seobserva más frecuentemente en pacientes con desequilibrioshidroelecrolíticos. No existe un tratamiento específicoy el pronóstico puede ser infausto. Presentamos un caso deMCP con buena respuesta a inmunoglobulinas.Caso clínico. Paciente mujer de 31 años con trastornobulímico, personalidad tipo impulsivo, potómana y hábitoenólico que tras ingreso en una unidad de cuidados intensivospor hiponatremia grave (104 mEq/l) con corrección en7 días presenta un cuadro rápidamente progresivo de disartriae inestabilidad de la marcha, tetraparesia y piramidalismo.Ante la sospecha de MCP se solicita resonancia magnéticaurgente, observándose una lesión hiperintensa en T2central, bilateral y simétrica de la protuberancia. Se inicia tratamientocon dexametasona con progresión clínica, por lo quese pauta tratamiento con inmunoglobulinas endovenosas,con una mejoría espectacular a partir del tercer día.Conclusiones. El tratamiento con inmunoglobulinaspuede ser una opción terapéutica a tener en cuenta en pacientescon MCP y progresión clínica tras el tratamiento habitual.Además esta respuesta abre interrogantes sobre unposible mecanismo disinmune en esta patología (AU)
Introduction. Central pontine myelinolysis (CPM) isa neurological condition with unknown pathogenesis. Itis most often observed in patients suffering hydroelectrolytedisturbances. There is no specific treatment and itcan have an unfortunate outcome. We present a case ofCPM that responded well to immunoglobulins Case report. The case of a 31 year old female patientwith bulimia, impulsive type personality, potomaniaand chronic alcoholism is presented. After admissionto the intensive care unit due to severe hyponatremia(104 mEq/l) with correction in 7 days, she had a rapidlyprogressive picture of dysarthria and gait instability, tetraparesisand pyramidalism. Due to suspected CPM,emergency magnetic resonance imaging was requested,observing a hypertense lesion in central, bilateral andsymmetric T2 of the pons. Treatment was initiated withdexamethasone with clinical progression so that i.v. immunoglobulintreatment was prescribed, with a spectacularimprovement after the third day.Conclusions. Treatment with immunoglobulins maybe a therapeutic option to consider in patients with CPMand clinical progression after the usual treatment. Furthermore,this response opens questions on a possibledysimmune mechanism in this disease (AU)
Assuntos
Humanos , Feminino , Adulto , Imunoglobulinas/farmacologia , Mielinólise Central da Ponte/tratamento farmacológico , Resultado do Tratamento , Imunização Passiva , Imunoglobulinas/administração & dosagem , PrognósticoRESUMO
INTRODUCTION: Central pontine myelinolysis (CPM) is a neurological condition with unknown pathogenesis. It is most often observed in patients suffering hydroelectrolyte disturbances. There is no specific treatment and it can have an unfortunate outcome. We present a case of CPM that responded well to immunoglobulins. CASE REPORT: The case of a 31 year old female patient with bulimia, impulsive type personality, potomania and chronic alcoholism is presented. After admission to the intensive care unit due to severe hyponatremia (104 mEq/l) with correction in 7 days, she had a rapidly progressive picture of dysarthria and gait instability, tetraparesis and pyramidalism. Due to suspected CPM, emergency magnetic resonance imaging was requested, observing a hypertense lesion in central, bilateral and symmetric T2 of the pons. Treatment was initiated with dexamethasone with clinical progression so that i.v. immunoglobulin treatment was prescribed, with a spectacular improvement after the third day. CONCLUSIONS: Treatment with immunoglobulins may be a therapeutic option to consider in patients with CPM and clinical progression after the usual treatment. Furthermore, this response opens questions on a possible dysimmune mechanism in this disease.
Assuntos
Imunoglobulinas Intravenosas/uso terapêutico , Mielinólise Central da Ponte/terapia , Adulto , Feminino , Humanos , Hiponatremia/complicações , Mielinólise Central da Ponte/etiologia , Mielinólise Central da Ponte/imunologia , Mielinólise Central da Ponte/patologiaRESUMO
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