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Título

A RARE CASE OF ALCOHOL-INDUCED OSMOTIC DEMYELINATION SYNDROME

RESUMO

CASE PRESENTATION: Male, 53 years old, is admitted to the emergency room with a subacute picture of dysarthria, central facial paralysis on the left and hemiparesis on the left with evolution of one week. The clinical condition began a day after an episode of alcoholic libation. Previously hypertensive, he made continuous use of telmisartan + amlodipine and chlorthalidone. According to family members, he consumed alcohol excessively on weekends, and after family deconjuncture this consumption was exacerbated. In the neurological examination, he was vigil, oriented in time and space, with severe dysarthria, facial paralysis of central pattern to the left, deviation of the uvula to the left, deviation of the ispilateral soft palate. He evolved with an asymmetric tetraparesis, with degree muscle strength (DMS) 2 in the left dimidium and DMS 4 in the right upper limb and DMS 2 in the right lower limb. Hoffman is present bilaterally. Slight tactile and painful hypoesthesia on the left. Right dysmetria in the index-nose test. The cerebrospinal fluid was clear and colorless, with an opening pressure of 22cmH2O, with normal cellularity, normal protein and glucose value. Contrast-enhanced nuclear magnetic resonance imaging (MRI) of the skull revealed the presence of a lesion in the brainstem, especially in a pons characteristic of pontine myenolysis, with hyposignal on T1-weighted sequences, hypersignal on T2-weighted sequences and Flair, measuring 3.1x3x2cm, bilaterally without circum edema. Intense contrast enhancement. Other similar lesions in splenium of the corpus callosum on the right and right occipital lobe. DISCUSSION: The most common cause of Osmotic Demyelination Syndrome (ODS) is the very rapid correction of chronic hyponatremia. Cases of alcohol-related non-hyponatraemic osmotic demyelination result from glycogen depletion and thiamine deficiency that limit the ability to adapt brain to any osmotic stress. The diagnosis is initially suspected from clinical symptoms and is confirmed by magnetic resonance imaging of the brain. FINAL CONSIDERATIONS: The authors describe a rare case of pontine and extra-pontine ODS not associated with hyponatremia. The causal factor in question was alcohol libation and the clinical diagnosis was possible from the clinical condition and the exclusion of other differential diagnoses, as well as the performance of the neuroimaging examination, which allowed the identification of the lesions.

Palavras Chave

Osmotic Demyelination; Pontine Myelinolysis; Extrapontine Myelinolysis

Área

Miscelânea