title: 'Wine Glass' sign in recurrent postpartum hypernatremic osmotic cerebral demyelination.
abstract: Osmotic demyelination syndrome resulting from postpartum hypernatremia is a recently described entity wherein young women present with hypernatremic encephalopathy and white matter hyperintensities along with quadriparesis from rhabdomyolysis. It is an acute monophasic condition with acute hypernatremia occurring during puerperium with good recovery in majority of the patients with treatment. To the best of our knowledge, recurrent postpartum hypernatremia with encephalopathy, osmotic demyelination, and rhabdomyolysis has not been described. We present a young lady who had two episodes of reversible postpartum hypernatremic encephalopathy with rhabdomyolysis. Cerebral magnetic resonance imaging (MRI) before treatment revealed osmotic demyelination on both occasions. During first admission MRI revealed hyperintensities in internal capsule and corpus callosum, and at second admission revealed more extensive white matter hyperintensity, which simulated the 'wine glass' appearance.
authors: Department of Neurology, KLE University's Jawaharlal Nehru Medical College and KLES Dr. Prabhakar Kore Hospital and MRC, Nehrunagar, Belgaum, Karnataka, India.
authors: Aralikatte O
authors: AO
authors: Saroja
authors: Karkal R
authors: KR
authors: Naik
authors: Rajendra V
authors: RV
authors: Mali
authors: Sanjeeva R
authors: SR
authors: Kunam
keywords: Hypernatremia; magnetic resonance imaging; osmotic demyelination; postpartum; ‘Wine-Glass’ sign
references: Obstet Gynecol. 2003 Nov;102(5 Pt 2):1166-8
references: 14607044
references: J Am Soc Nephrol. 2010 Apr;21(4):570-2
references: 19959721
references: N Engl J Med. 1994 Aug 18;331(7):439-42
references: 8035840
references: Neurol India. 2002 Sep;50(3):306-9
references: 12391458
references: J Neurol Neurosurg Psychiatry. 2011 Mar;82(3):326-31
references: 20826870
references: Ann Intern Med. 1996 Jan 15;124(2):197-203
references: 8533994
references: J Neuroradiol. 2006 Oct;33(4):229-36
references: 17041527
references: AJNR Am J Neuroradiol. 2010 Nov;31(10):1769-77
references: 20360339
references: Radiology. 1989 Aug;172(2):535-9
references: 2748836
references: Expert Rev Neurother. 2011 Oct;11(10):1485-96
references: 21955203
references: N Engl J Med. 2000 May 18;342(20):1493-9
references: 10816188
references: Neurology. 1997 Nov;49(5):1392-9
references: 9371928
references: Endocr J. 2010;57(12):1023-8
references: 20953066
references: J Child Neurol. 1999 Jul;14(7):428-33
references: 10573464
references: Clin Neurol Neurosurg. 2009 Jun;111(5):477-9
references: 19217203
references: J Neuropathol Exp Neurol. 1996 Jan;55(1):106-13
references: 8558165
references: Neuroradiology. 1991;33(6):524-6
references: 1780056
references: J Neurol Sci. 2010 Apr 15;291(1-2):5-11
references: 20129624