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Lithium treatment increases endothelial cell survival and autophagy in a mouse model of Fuchs endothelial corneal dystrophy

2013; BMJ; Volume: 97; Issue: 8 Linguagem: Inglês

10.1136/bjophthalmol-2012-302881

1468-2079

Eun Chul Kim, Huan Meng, Albert S. Jun,

Corneal surgery and disorders

OBJECTIVE: To describe an unusual case presentation of osmotic demyelination syndrome BACKGROUND: Osmotic demyelination syndromes (ODS) are well established complications of the rapid correction of sodium (Na). It is influenced by the rate of correction, the chronicity of the imbalance, and the etiology of the hyponatremia. DESIGN/METHODS: Single case report RESULTS/Case report: 23 y/o man presented with metabolic encephalopathy secondary to symptomatic severe hyponatremia (Na 112 mEq/L) from medication non-compliance after prior surgical resection of a pituitary adenoma. Physiological steroids and thyroid hormone supplementation were initiated in view of clinical panhypopituitarism. His Na corrected by 17mEq/24 hours. Latent diabetes insipidus was unmasked and he was started on DDAVP. His clinical course was characterized by initial improvement of the encephalopathy followed by neurologic deterioration on day 3. He had fluctuating episodes of mutism and bradykinesia without significant motor symptoms. Initial MRI done on day 5 was not suggestive of ODS. MRI on day 10 revealed interval development of swelling in the caudate and lenticular nuclei consistent with Extra Pontine Myelinolysis (EPM). The patient was started on intravenous immunoglobulin (IVIG) and clinical status improved dramatically after 2 doses with return to baseline. CONCLUSIONS: Untreated cases of adrenal insufficiency often present with severe hyponatremia and are vulnerable to the subsequent complications of care. Most physicians cautiously correct the Na deficit and closely monitor for the motor manifestations associated with central pontine myelinolysis (CPM). However, EPM can present with more subtle psychiatric manifestations and may be overlooked. Isolated EPM occurs in about 40 [percnt] of ODS cases and can manifest with a wide array of non-specific neuropsychiatric symptoms. Case studies have reported therapeutic efficacy of IVIG with varying degrees of success. Radiologic imaging, high index of clinical suspicion and prompt intervention is the key to clinical redemption in such patients Disclosure: Dr. Chandra has nothing to disclose. Dr. Peicher has nothing to disclose. Dr. Sudhakar has nothing to disclose. Dr. Varghese has nothing to disclose.