Extrapontine myelinolysis in a patient with systemic lupus erythematosus

A case report

Ming Han Tsai, Chin Song Lu, Chi Jen Chen, Wen Pin Tsai, Lieh Bang Liou

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in systemic lupus erythematosus (SLE) is rare and related pathologic changes in brain images have not been reported. We report the case of a 49-year-old woman with SLE who developed extrapontine myelinolysis (EPM) following gradual correction of marked hyponatremia caused by SIADH. EPM was caused by the hyponatremia, which resulted in cerebral hypoxia and brain swelling. SIADH was most likely induced by the occult vasculitis of SLE. After partial correction of hyponatremia, she regained consciousness, but gradually developed parkinsonism including rigidity, bradykinesia, and tremors 1 week later. Magnetic resonance imaging revealed bilateral symmetrical brain lesions at the putamen, globus pallidus, and part of the thalamus. These symptoms improved gradually after administration of levodopa. Mild jerky tremors of both hands persisted 4 months later. The EPM lesions differ from those observed in central pontine myelinolysis (CPM), which is immediately induced by acute correction of hyponatremia. Therefore, hyponatremia in lupus-related SIADH should be carefully corrected to prevent CPM or EPM.

Original languageEnglish
Pages (from-to)505-508
Number of pages4
JournalJournal of the Formosan Medical Association = Taiwan yi zhi
Volume101
Issue number7
Publication statusPublished - Jul 2002
Externally publishedYes

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Central Pontine Myelinolysis
Hyponatremia
Systemic Lupus Erythematosus
Vasopressins
Tremor
Inappropriate ADH Syndrome
Brain Hypoxia
Hypokinesia
Globus Pallidus
Putamen
Brain Edema
Brain
Parkinsonian Disorders
Levodopa
Vasculitis
Consciousness
Thalamus
Hand
Magnetic Resonance Imaging

Keywords

  • Extrapontine myelinolysis
  • Hyponatremia
  • Systemic lupus erythematosus

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Extrapontine myelinolysis in a patient with systemic lupus erythematosus : A case report. / Tsai, Ming Han; Lu, Chin Song; Chen, Chi Jen; Tsai, Wen Pin; Liou, Lieh Bang.

In: Journal of the Formosan Medical Association = Taiwan yi zhi, Vol. 101, No. 7, 07.2002, p. 505-508.

Research output: Contribution to journalArticle

Tsai, Ming Han ; Lu, Chin Song ; Chen, Chi Jen ; Tsai, Wen Pin ; Liou, Lieh Bang. / Extrapontine myelinolysis in a patient with systemic lupus erythematosus : A case report. In: Journal of the Formosan Medical Association = Taiwan yi zhi. 2002 ; Vol. 101, No. 7. pp. 505-508.
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