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Published on: August 28, 2020
Neurogenic bladder due to hypoxic-ischemic demyelination.
Sindhu Ramchandren1, David S Liebeskind
1University of Michigan Health System, Neurology, Ann Arbor, MI 48109, USA. sindhur@med.umich.edu
Summary
Hypoxic-ischemic demyelination, a rare condition, can cause neurogenic bladder after severe injury. This case highlights isolated white matter changes as a potential cause, distinct from typical cortical damage.
Area of Science:
- Neurology
- Neuroscience
- Pathology
Background:
- Hypoxia commonly affects neuronal cell bodies.
- Demyelination is an infrequent but known consequence of hypoxia.
- Posthypoxic demyelination is rarely described, especially isolated white matter changes.
Observation:
- A 46-year-old man developed neurogenic bladder (urinary urgency, hyperactive reflexes, Babinski signs) after a severe motor-vehicle accident with massive blood loss.
- Brain and cervical cord MRI revealed diffuse, isolated white matter abnormalities consistent with Wallerian degeneration.
- Serologic and cerebrospinal fluid evaluations were normal.
Findings:
- The patient presented with neurogenic bladder following global hypoxia-ischemia.
- MRI demonstrated isolated white matter signal abnormalities and Wallerian degeneration in the brain and spinal cord.
- Cortical abnormalities, typically seen in hypoxic-ischemic injury, were absent.
Implications:
- This case suggests hypoxic-ischemic demyelination affecting white matter can lead to neurogenic bladder.
- Physicians should consider isolated white matter changes from global hypoxia-ischemia as an etiology for neurogenic bladder.
- This finding expands the understanding of demyelination consequences beyond cortical involvement.
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