Osmotic Demyelination Syndrome due to Rhabdomyolysis and Hyperosmolar Hyperglycemic Syndrome following Cardiogenic Shock.

Osmotic demyelination syndrome (ODS) is a relatively rare disease that causes rapid demyelination, resulting in pontine and central nervous system damage with various symptoms, including impaired consciousness. It often occurs when hyponatremia is rapidly corrected. However, it can also occur when a normonatremic patient suddenly develops hypernatremia. A 51-year-old man developed cardiogenic shock with impaired consciousness, hyperCKemia, hypernatremia, and hyperglycemia. Osmotic demyelination syndrome secondary to rhabdomyolysis and hyperosmolar hyperglycemic syndrome was suspected. The patient's fluid volume decreased because of osmotic diuresis caused by hyperglycemia, and the blood sodium level increased rapidly. The latter resulted in ODS, which in turn resulted in a prolonged disturbance of consciousness, from which he has not yet recovered. ODS has been reported as a serious complication of rapid correction of hyponatremia, although it also occurs when normonatremia leads to hypernatremia. This disease is difficult to diagnose, as magnetic resonance imaging (MRI) of the brain is often unremarkable several weeks after its onset. This case of ODS occurred when normonatremia led to hypernatremia, as a result of rhabdomyolysis and hyperosmolar hyperglycemic syndrome. Diagnosis was made based on the MRI brain findings.

Analysis of clinical usefulness of the heat flux technique: predictability of the recovery from neurosensory disturbances in the chin undergoing mandibular sagittal split ramus osteotomy.

OBJECTIVE: To examine the prognosis of the neurosensory disturbance (NSD) in the chin after bilateral sagittal split ramus osteotomy (BSSRO), using the heat flux technique. STUDY DESIGN: Twenty-nine patients (total 58 sides) undergoing BSSRO were examined. The warm sensory threshold (WHF) and cold sensory threshold (CHF) in the chins of these patients were measured by the heat flux technique. Touch sensory threshold (TS) was measured by an Semmes-Weinstein esthesiometer. Touch sensory disturbance was subjectively evaluated by visual analog scale. RESULTS: At all of the postoperative time points, there were no significant differences in the incidence rate among all tests (chi-squared test; P > .05). WHF, CHF, and TS were significantly correlated with the subjective evaluation. Recovery from NSD was delayed in cases that the postoperative variation of 2 weeks was >400 W/m(2) in WHF and CHF and the filament marking at 2 weeks after surgery was >3.5 in TS. CONCLUSION: The heat flux technique appears to be a useful method for the prediction of the recovery from NSD in the chin.

A new evaluation method for neurosensory disturbance in the chin of patients undergoing mandibular sagittal split ramus osteotomy: an application of the heat flux technique.

OBJECTIVE: To examine neurosensory changes in the chin following bilateral sagittal split ramus osteotomy (BSSRO) using the heat flux technique. STUDY DESIGN: Twelve healthy adults (C-group) and 23 patients undergoing BSSRO (P-group) were examined. The warm sense threshold (WHF) and cold sense threshold (CHF) in the chin of these patients were measured by the heat flux technique. In the P-group, touch sensation also was measured with a visual analog scale (VAS) and the Semmes-Weinstein monofilament test (SW test). RESULTS: Both WHF and CHF were significantly larger in the P-group than in the C-group (P = .024). Touch sensation (VAS and SW test) were damaged in some patients of the P-group. However, no correlation was revealed between thermal sensation (WHF and CHF) and touch sensation (VAS and SW test) in the P-group. CONCLUSIONS: These results suggest that the thermal sensation in the chin was damaged after BSSRO. The heat flux technique appears to be one of the useful methods for the examination of neurosensory disturbance in the chin.