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Korean J Anesthesiol. 2010 Dec;59 Suppl:S197-200. doi: 10.4097/kjae.2010.59.S.S197. Epub 2010 Dec 31.

Extensive demyelinating change in cerebrum after a total knee replacement -A case report-.

Author information

  • 1Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Korea.

Abstract

Demyelination is characterized by the loss of myelin with the preservation of axons. Demyelinating diseases can be classified into several categories: demyelination due to inflammation, viral infection, osmotic derangements and hypoxic ischemia. In particular, osmotic myelinolysis is representative, and is associated with hyperosmolality, hypokalemia or rapid correction of hyponatremia. Osmotic myelinolysis was reported to be associated with underlying conditions, such as alcoholism, diuretics and malnutrition. A 67-year-old woman with hypertension was scheduled to undergo both total knee replacements (TKR). She was observed to be lethargic with dysphagia and quadriplegia after the second TKR. She had been taking diuretics for a long time, and did not have an adequate amount of food intake due to patient controlled analgesia and a gastric ulcer after the first TKR. A laboratory examination revealed hypokalemia but normonatremia. T2 weighted-MRI revealed abnormal high signal intensity in the basal ganglia and periventricular area. This case was diagnosed with osmotic myelinolysis associated with hypokalemia without an apparent sodium imbalance.

KEYWORDS:

Demyelinating diseases; Hypokalemia; Osmotic myelinolysis; Total knee replacement

PMID:
21286440
[PubMed]
PMCID:
PMC3030036
Free PMC Article

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