Central pontine myelinolysis in the presence of SARS-CoV-2 infection (clinical observations)

O N Voskresenskaya,A A Kovalenko,V V Grinyuk,A V Klimanov,Yu M Shor,E B Nadbitova

doi:10.14412/2074-2711-2021-2-91-96

O N Voskresenskaya, A A Kovalenko + Show 4 more

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https://doi.org/10.14412/2074-2711-2021-2-91-96

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Abstract

Osmotic demyelinating syndrome (ODS) is a severe complication that occurs due to rapid correction of hyponatremia. Central pontine myelinolysis (CPM), in which a focus of demyelination occurs in the pontine region, and extrapontine myelinolysis (EPM), in which foci of demyelination appear in the white matter of the cerebral hemispheres, can be distinguished as a part of this syndrome. We describe two clinical cases of CPM that developed due to hyponatremia and hypokalemia in patients with SARS-CoV-2 infection (COVID-19). Differential diagnosis included acute disseminated encephalomyelitis, infectious encephalitis, and brain tumor. In both cases, a significant recovery of the lost functions was noted. The pathogenetic mechanisms of CPM development in patients with COVID-19 are discussed. ODS development in COVID- 19 necessitates strict control and correction of electrolyte disturbances in this category of patients in accordance with existing recommendations, which can reduce the risk of CPM.

Highlights

Central pontine myelinolysis in the presence of SARS-CoV-2 infection Voskresenskaya O.N, Kovalenko А.А., Nadbitova Е.B., Grinyuk V.V., Klimanov A.V., Shor Yu.M
Osmotic demyelinating syndrome (ODS) is a severe complication that occurs due to rapid correction of hyponatremia
Central pontine myelinolysis (CPM), in which a focus of demyelination occurs in the pontine region, and extrapontine myelinolysis (EPM), in which foci of demyelination appear in the white matter of the cerebral hemispheres, can be distinguished as a part of this syndrome

Summary

Introduction

Central pontine myelinolysis in the presence of SARS-CoV-2 infection (clinical observations) Voskresenskaya O.N, Kovalenko А.А., Nadbitova Е.B., Grinyuk V.V., Klimanov A.V., Shor Yu.M. Наиболее вероятной гипотезой развития ЦПМ является коррекция хронической гипонатриемии при снижении уровня натрия в крови ниже 120 ммоль/л (норма 135–145 ммоль/л) в течение 48 ч и более. Больной была выполнена компьютерная томография (КТ) органов грудной клетки: КТ-картина двусторонней пневмонии вирусной этиологии, высокая вероятность COVID-19, в связи с чем пациентка госпитализирована в инфекционный стационар, где впоследствии был подтвержден диагноз.

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