Korean J Anesthesiol.  2010 Dec;59(Suppl):S197-S200. 10.4097/kjae.2010.59.S.S197.

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

• Park SJ
• Kim SD
• Jee DL
• Byun WM

• KMID: 2237387
• DOI: http://doi.org/10.4097/kjae.2010.59.S.S197

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.

Keyword

Demyelinating diseases; Hypokalemia; Osmotic myelinolysis; Total knee replacement

MeSH Terms

Aged
Alcoholism
Analgesia, Patient-Controlled
Arthroplasty, Replacement, Knee
Axons
Basal Ganglia
Cerebrum
Deglutition Disorders
Demyelinating Diseases
Diuretics
Eating
Female
Humans
Hypertension
Hypokalemia
Hyponatremia
Inflammation
Ischemia
Knee
Malnutrition
Myelin Sheath
Quadriplegia
Sodium
Stomach Ulcer
Diuretics
Sodium