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Extensive demyelinating change in cerebrum after a total knee replacement -A case report-
Sang-Jin Park1, Seung-Dong Kim, Dae-Lim Jee
1Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Korea.
Korean Journal of Anesthesiology
|February 3, 2011
Summary
Osmotic myelinolysis, a demyelinating disease, can occur with hypokalemia (low potassium) even without sodium imbalance. This case highlights the importance of electrolyte monitoring after surgery, especially in patients with risk factors like diuretic use.
Area of Science:
- Neurology
- Pathology
Background:
- Demyelination involves myelin loss while preserving axons.
- Osmotic myelinolysis is a specific type linked to electrolyte imbalances and certain conditions.
- Risk factors include alcoholism, diuretic use, and malnutrition.
Purpose of the Study:
- To report a case of osmotic myelinolysis.
- To highlight its association with hypokalemia without hyponatremia.
- To discuss implications for clinical practice.
Main Methods:
- Case study of a 67-year-old woman undergoing total knee replacements.
- Clinical observation of neurological deficits (lethargy, dysphagia, quadriplegia).
- Laboratory tests (electrolytes) and T2-weighted MRI.
Main Results:
- The patient developed neurological symptoms post-surgery.
- Laboratory results showed hypokalemia with normonatremia.
- MRI revealed characteristic high signal intensity in the basal ganglia and periventricular areas.
Conclusions:
- Osmotic myelinolysis can occur due to hypokalemia alone.
- This case underscores the need for careful electrolyte monitoring in at-risk patients.
- Diuretic use and poor nutritional intake are significant contributing factors.
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