Postpartum hypernatremic cerebral encephalopathy with osmotic myelinolysis: Report of two cases and review with emphasis on magnetic resonance imaging findings

• Main Authors: Santosh Rai Phajir Vishwanath, Mithun Sekhar, Keerthiraj Bele, Rakshith Kedambadi Chandrashekar
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2015-01-01
• Series: International Journal of Advanced Medical and Health Research
• Subjects: Demyelination; encephalopathy; hypernatremia
• Online Access: http://www.ijamhrjournal.org/article.asp?issn=2349-4220;year=2015;volume=2;issue=2;spage=112;epage=115;aulast=Phajir
• ISSN: 2349-4220; 2350-0298

Postpartum complications are diverse. Electrolyte imbalance with hypernatremia can occur secondary to underlying postpartum complication or can arise de novo. Hypernatremia causes demyelination similar to hyponatremia but predominantly involves extra-pontine structures. Here, we present two cases, one classical and another a variant of a recently described entity called postpartum hypernatremic encephalopathy with osmotic demyelination. The more classical appearance is altered signal intensity changes in the posterior limb of internal capsules, external capsule, crus cerebri, corticopontine tracts, middle cerebellar peduncle, hippocampus, fornix, and cerebellar white matter with classical wine glass appearance on coronal T2-weighted images. The nonclassical case shows a different and atypical imaging finding of the same disease with small focal transient altered signal intensity changes in the splenium of corpus callosum. Both the patients recovered with conservative management of the electrolyte imbalance.