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362876

Late Presenting Central Pontine Myelinolysis Post-tonsillectomy in a Child: Case Report

Article

Last updated: 25 Dec 2024

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Tags

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Abstract

Central pontine myelinolysis (CPM) is a notorious grave complication of rapid correction of hyponatremia. CPM is a noninflammatory demyelination. It presents clinically with variable degrees of loss of coordination, unconsciousness, blurred vision, cranial nerve affection, progressive spasticity, quadriparesis, pseudo bulbar palsy up to locked in syndrome, coma and death.  We report a 4.5-year-old who presented to emergency room (ER) with generalized tonic-clonic seizures, and sepsis. His parents reported that he underwent un-eventful tonsillectomy 3 days earlier. Two days post-tonsillectomy he developed fever. On third day post-tonsillectomy he developed an attack of convulsions at home, 3 hours prior to presenting to ER. He presented to the ER by another attack of seizures. His seizures were controlled on IV midazolam and levetiracetam loading dose. His conscious level was clouded beyond the postictal 30 minutes. His Glasgow Coma scale was 12 which necessitated Pediatric Intensive Care Unit (PICU) admission. His condition was complicated by acute liver and kidney injury that improved within 48 hours. Upon admission his sodium level was 141 mmol/L, and did not drop below 140 mmol/L all through the hospital stay. By the 7th day after admission the child developed left sided convergent squint (6th cranial nerve palsy) and progressive spasticity. Magnetic resonance imaging revealed CPM. The isolated CPM in this child developed irrespective of hemodynamic stability, lack of hyponatremia and its rapid correction. CPM in our studied child might be an isolated presentation of sepsis associated encephalopathy, or a late complication post-tonsillectomy.

DOI

10.21608/cupsj.2024.296772.1134

Keywords

Central Pontine Myelinolysis, post-tonsillectomy, Child, Sepsis

Authors

First Name

Magd

Last Name

Kotb

MiddleName

Ahmed

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt

Email

magdkotb@kasralainy.edu.eg

City

-

Orcid

0000-0003-2118-3793

First Name

Mennat-allah

Last Name

El zabet

MiddleName

Mahmoud

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt

Email

menaallah.m.mohammed@students.kasralainy.edu.eg

City

-

Orcid

-

First Name

Walaa

Last Name

El Naggar

MiddleName

-

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt

Email

walaa_elnaggar@yahoo.com

City

cairo

Orcid

0000-0003-1590-7695

Volume

4

Article Issue

2

Related Issue

48747

Issue Date

2024-07-01

Receive Date

2024-06-10

Publish Date

2024-07-01

Page Start

114

Page End

117

Print ISSN

2805-279X

Online ISSN

2682-3985

Link

https://cupsj.journals.ekb.eg/article_362876.html

Detail API

https://cupsj.journals.ekb.eg/service?article_code=362876

Order

362,876

Type

Case Report

Type Code

1,279

Publication Type

Journal

Publication Title

Pediatric Sciences Journal

Publication Link

https://cupsj.journals.ekb.eg/

MainTitle

Late Presenting Central Pontine Myelinolysis Post-tonsillectomy in a Child: Case Report

Details

Type

Article

Created At

25 Dec 2024