00:02
Our topic here is Acute
Disseminated Encephalomyelitis.
00:06
So what does this mean to you?
If you take a look
at the picture here,
it's a monophasic
demyelinating disease
that most commonly will be
following a viral infection or
a patient has
received immunization.
00:19
That's important, it's got acute
disseminated encephalomyelitis.
00:24
Please look for viral infection,
and then following which may
result in edema leading disease.
00:31
Symptoms develop a week or two
after the antecedent infection.
00:35
Diffuse brain involvement: headache,
lethargy, coma, in some cases.
00:41
Prognosis: Well, hear,
recovery typically near complete.
00:46
For the most part,
this particular issue goes away,
as long as you're able
to properly provide
the supportive therapy
for the viral infection,
and immunomodulatory therapy
with high dose methylprednisolone.
01:01
Like, less than 1/3 however,
will go onto multiple sclerosis
in the future.
01:04
So keep that in mind as well.
01:06
They want to think of this
as being perhaps
something like pre
multiple sclerosis,
if that helps you.
01:11
This was important pay attention
to ADE viral infection.
01:19
This is transverse myelitis.
01:21
I'll give you one clinical pearl.
01:24
Stay away from the brain
in this condition, okay.
01:28
The reason I say that
if you say myelo,
you'll notice there's no encephalo.
01:32
In addition,
take a look at the schematic here.
01:36
There's no brain
pictured here on purpose.
01:39
So, it's a demyelinating event
restricted to the spinal cord.
01:43
Way back when, when we talked
about spinal cord pathology
or when you have reviewed it.
01:49
We talked about transverse myelitis
as being the possible cause
of trauma
to the spinal cord.
01:54
Here you have it.
01:55
There is no evidence
of brain lesion
that is the absolute clinical pro
that you want to take out of this.
02:01
Can be in isolation or associated
with autoimmune disorders
such as Sjögren.
02:06
Treated with
steroids and plasmapheresis.
02:09
Why? Because you're thinking
about autoimmune diseases,
and can be recurrent is
called transverse myelitis.
02:16
Look for autoimmune diseases
for the most part,
inflammation of the spinal cord
with no involvement of the brain.
02:27
Our next topic,
your patient comes in and
well, was taking carbamazepine.
02:33
Why? Or to treat perhaps
trigeminal neuralgia.
02:37
As a side effect, we get labs.
02:40
And under labs it shows
that your sodium levels.
02:41
Sodium levels is 125.
02:44
Would you please put together?
Carbamazepine a sodium level,
that is what?
Decreased, hyponatremia.
02:52
That your patient is coming in
with hyponatremia.
02:54
You want to correct this.
You want to correct this.
02:57
Unbeknownst to the resident,
unbeknownst to the intern,
Get all anxious,
and extremely happy,
and we wanted to correct this,
and so therefore, to rapidly
corrects the hyponatremia.
03:10
And in the process results
in a condition called
central pontine myelinolysis.
03:19
What's happening?
Allowed the name to speak to you.
03:22
The pons, you're in the brainstem.
03:24
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.
03:31
The lesion is in the
central portion, the pons.
03:32
What's happening?
Demyelination.
03:35
Why?
Well, there are many
theories out there.
03:37
At this point, what you're
correcting for, too rapidly
was the hyponatremia.
03:43
So what was there trying to say
with carbamazepine?
Carbamazepine
causes a side effect of SIADH,
syndrome of inappropriate
antidiuretic hormone.
03:53
With too much ADH, what then
happens your sodium levels?
Hyponatremia.
03:58
And if you want to
correct it too quickly,
there's every possibility that
the patient may suffer from
central pontine myelinolysis.
04:05
That’s unfortunate.
04:05
This whole thing
could have been prevented.
04:08
And really,
the next step of management
was to take the patient off
the carbamazepine.
04:13
In this particular case,
it could be also seen
with alcoholics.
04:17
Anything that causes hyponatremia,
and there's rapid correction.
04:21
It is the basis pontus classically,
but could be other sites as well.
04:25
Keep that in mind.
04:26
Never, never correct
your hyponatremia to rapidly.
04:30
Present with look at this,
look at manifestations,
it's devastating.
04:35
It's tetraplegia, quadriplegia.
04:37
The patient loses
all ability to move.
04:41
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.
04:49
Could you imagine
how the patient is going to feel?
Because not you,
but someone that you know,
rapidly corrected
the hyponatremia.
05:00
Common presentation:
What you're going to find?
Acute paralysis.
05:05
Maybe dysarthria,
difficulty with speaking
and dysphagia,
you're knocked out the brainstem.
05:10
Holy cow, no joke.
What happened?
Don't correct the serum sodium
to more than 10 units per 24 hours.
05:17
Clear?
Memorize that.
05:19
Memorize that, and only then are you permitted to move on.