Síndrome da desmielinização osmótica em um paciente com polidipsia psicogênica: relato de caso

Abstract

Objective: to describe the clinical picture of a 43-years-old patient who developed psychogenic polydipsia, admitted in the emerency room with a hypotonic hypovolemic hyponatremia, evolving posteriorly with osmotic demyelination syndrome. Case report: patient, 43-years-old, developed psychogenic polydipsia, evolving into hypotonic hypovolemic hyponatremia. Admitted in the emergency room after a head trauma, with adynamia, sleepiness, nausea and dehydration signs.Realized correction of the hyponatremia with intravenous sodium solution. Two days after hospitalization, showed important decrease in the level of consciouness, needing transfer to the ICU. Magnetic resonance imaging of brain made after two months of the admission on emergency room showed signs os pontine myelinolyses. Discussion:the osmotic demyelination syndrome is a neuroloic condition that affects both the pons and extrapontine areas and is related with the rapid correction of chronic hyponatremia. Deserve highlight alcoholic patients, liver transpanted patients, severely burned and malnourished. The clinical presentantion is related with the site of the lesions in the central nervous system. Diagnosis is made with magnetic resonance. Conclusion: knowledge about osmotic demyelination syndrome is important to prevent new cases, in viem of the fact that patients can be fully dependent of care and be subjected to complications, or even die directly from de injuries in the central nervous system.