title: [Case of neuromyelitis optica spectrum disorder associated with central pontine and extrapontine myelinolysis preceded by syndrome of inappropriate antidiuretic hormone secretion].
abstract: A 36-year-old woman complained of general malaise. She presented with hyponatremia and plasma osmotic pressure was lower than urinary osmotic pressure. In addition, serum antidiuretic hormone level was higher than the measurement sensitivity. She was diagnosed with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). She fell into a coma despite correction of serum sodium level. Brain magnetic resonance imaging (MRI) revealed high signal intensities in the cerebral cortex, striatum, thalamus, hypothalamus, midbrain, and pons in fluid-attenuated inversion recovery images. Spinal MRI revealed a longitudinally extending lesion in the cervical cord. Serum sample was positive for anti-aquaporin-4 antibody, supporting the diagnosis of neuromyelitis optica spectrum disorder (NMOSD) combined with central pontine and extrapontine myelinolysis. In patients with NMOSD, the immune reaction can gradually cause destructive changes of the hypothalamus and lead to unstable ADH secretion in the absence of immunomodulatory treatment.
authors.affiliation: Department of Clinical Neuroscience, The University of Tokushima Graduate School.
authors.forename: Waka
authors.initials: W
authors.lastname: Sakai
authors.forename: Naoko
authors.initials: N
authors.lastname: Matsui
authors.forename: Koji
authors.initials: K
authors.lastname: Fujita
authors.forename: Yuishin
authors.initials: Y
authors.lastname: Izumi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Nishida
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanbayashi
authors.forename: Ryuji
authors.initials: R
authors.lastname: Kaji
mesh_terms: D000328:Adult; D051401:Aquaporin 4 / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001921:Brain / Q000473:pathology; D006801:Humans; D007177:Inappropriate ADH Syndrome / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D017590:Myelinolysis, Central Pontine / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D009471:Neuromyelitis Optica / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D010951:Plasma Exchange; D011239:Prednisolone / Q000008:administration & dosage; D020551:Pulse Therapy, Drug; D012964:Sodium / Q000097:blood; D016896:Treatment Outcome
chemical_list: C496030:AQP4 protein, human; D051401:Aquaporin 4; D015415:Biomarkers; D012964:Sodium; D011239:Prednisolone; D008775:Methylprednisolone