Our topic here is acute
So, what does this mean to you?
If you take a look
at the picture here,
were affecting the spinal cord and
were affecting the parenchyma,
as well of the brain.
It’s a monophasic demyelinating disease
that most commonly will be
following a viral infection
or a patient has
It’s got acute disseminated
Please look for a
and then following which may
result in a demyelinating disease.
Symptoms develop a week or two
after the antecedent infection.
Diffuse brain involvement: headache,
lethargy, coma in some cases.
Prognosis: Well, here, recovery typically
near complete, thank goodness,
because here for the most part,
as long as you’re able to properly
provide the supportive therapy
for the viral infection, then perhaps,
this particular issue goes away.
Less than one-third, however, will go
on to multiple sclerosis in the future.
So, keep that in mind as well.
We want to think of this of being, perhaps,
something like pre-multiple sclerosis,
if that helps you.
This one's important, pay
attention to ADE viral infection.
This is transverse myelitis.
I’ll give you one clinical pearl.
Stay away from the brain
in this condition, okay?
The reason I say that is if you say myelo-,
you’ll notice there’s no encephalo-.
In addition, take a look
at the schematic here.
There’s no brain pictured
here on purpose.
So, it’s the demyelinating event
restricted to the spinal cord.
Way back when, when we talked
about spinal cord pathology
or when you have reviewed it,
we talked about transverse myelitis
as being a possible cause of trauma
to the spinal cord.
Here you have it.
There’s no evidence of brain lesion.
That is the absolute clinical pearl
that you want to take out of this.
It can be in isolation or associated
with autoimmune disorders such as
Sjogren's, you have
your la, right?
What am I talking about?
Your SSA, ro and la.
SSA is going to be your ro,
whereas, SSB will be your la.
It’s extremely important when you do
autoimmune diseases with Sjogren's.
Treated with steroids
Because you’re thinking
about autoimmune diseases.
And can be recurrent
This is called
Look for autoimmune diseases.
For the most part,
inflammation of the spinal cord
with no involvement of the brain.
Our next topic.
Your patient comes in and, well,
was taking carbamazepine.
To treat, perhaps,
It has a side effect.
We get labs, and on the labs, this
shows that your sodium level is 125.
Would you please put together carbamazepine
and sodium level that is, what?
That’s your patient that’s
coming in with hyponatremia.
You want to correct this,
you want to correct this unbeknownst to
the resident, unbeknownst to the intern.
Get all anxious and extremely happy
and wanting to correct this.
So therefore, too rapidly,
corrects the hyponatremia,
and in the process, results in a condition
called central pontine myelinolysis.
Allow the name to speak to you.
You’re in the brain stem.
What’s happening in the
central portion of the pons?
If you take a look at the picture here,
it clearly tells you what’s happening.
The lesion is in the
central portion of pons.
Well, there are many
theories out there.
At this point, what you’re correcting
for too rapidly was the hyponatremia.
So, what was I trying to
say with carbamazepine?
Carbamazepine causes side effect of SIADH,
syndrome of inappropriate
With too much ADH, what then
happens to your sodium levels?
And if you want to correct it too
quickly, there’s every possibility that
the patient may suffer from
central pontine myelinolysis.
This whole thing could
have been prevented.
And really, the next step
of management was to
take the patient off the carbamazepine
in this particular case.
It could be also seen
anything that causes hyponatremia,
and there’s rapid correction.
It is the basis
but it could be other sites
as well, keep that in mind.
Never, never correct your
hyponatremia too rapidly.
Look at this, look at the manifestations.
It’s devastating, it’s tetraplegia, quadriplegia,
the patient loses all
ability to move.
“I’m locked in.”
Isn’t that a horrible feeling?
You have all your limbs, you’re completely
aware but yet, you can’t move anything.
Could you imagine how the
patient is going to feel?
Because, not you, but someone that you know
rapidly corrected the hyponatremia.
What are you going to find?
maybe dysarthria, difficulty
with speaking, and dysphagia,
you’ve knocked out
the brain stem.
Holy cow! No joke.
Don’t correct the serum sodium to more
than 10 units for 24 hours, clear?
Memorize that, memorize that, and only
then are you permitted to move on.