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  • Extrapontine Myelinolysis with Hypernatremia in an Infant: A Case Illustration

    Final Number:

    Jacob B. Archer MD; Wei Huff MD; Andrew H. Jea MD, MHA

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Central pontine myelinolysisis is the typical osmotic dymyelination syndrome and characterized by hemorrhage and axonal injury in the pons. A more rare variant of this disease is extrapontine myelinolysis and can present with multifocal intraparenchymal hemorrhage.

    Methods: We present a 15-month-old boy with Down syndrome who was found to have multifocal intracranial hemorrhage upon admission.

    Results: The patient experienced two days of decreased oral intake and vomiting prior to admission. Upon admission he would not open eyes and would withdrawal to stimulation. Admission sodium was 220. The patient died later on admission day due to cardiovascular collapse. Autopsy was consistent with extrapontine myelinolysis.

    Conclusions: This is the fifth published case of pediatric EPM due to hypernatremia and the highest admission sodium out of the series. It is important to be aware of this disease entity as an etiology for intracranial hemorrhage and emphasize careful correction of osmotic derangements.

    Patient Care: This is a rare disease entity and will help physicians recognize and quickly and effectively treat.

    Learning Objectives: Participants should be able to describe the importance of hypovolemia and hypernatremia in the pediatric patient. They should also be able to recognize this disease entity radiographically as well as safely treat the underlying etiology.


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