Abstract|Neuro Critical Care 1| Volume 357, SUPPLEMENT 1, e60, October 15, 2015

Postpartum hypernatremic encephalopathy with osmotic cerebral demyelination syndrome and rhabdomyolysis : a unique life-threatening entity

      Background: Hypernatremia produces encephalopathy, osmotic demyelination syndrome and rhabdomyolysis. Postpartum hypernatremic encephalopathy with rhabdomyolysis was recently described.
      Objective: To document the clinical, biochemical and radiological spectrum of postpartum hypernatremic encephalopathy.
      Methods: Records of women with postpartum hypernatremia from 2007 to 2013 were reviewed. Details of clinical presentation, neurological deficits, biochemical and radiological abnormalities were gathered.
      Results: Twenty-six women with postpartum hypernatremia were treated during this period with age range of 18 to 37 years (23.38 ± 4.14). Symptoms consisted of fever (24), delirium (23), altered consciousness (19), progressive quadriparesis (9), ataxia (5), and seizures (3). Symptoms began 2 to 42 days (10.62 ± 9.06) after delivery. Twenty-five patients were in altered consciousness and 17 had proximally dominant weakness at admission. Muscle stretch reflexes were brisk in 15, plantar response extensor in 18 and corticobulbar signs in 8. Initial serum sodium ranged from 151 to 230 (183.92 ± 18.71) mEq/L with elevated chloride (149.05 ± 19.97 mEq/L), urea (114.40 ± 54.59 mg/dl), creatinine (3.16 ± 1.95 mg/dl) and serum osmlquences (corpus callosum 22, centrum semiovale 18, internal capsule 19 and thalamus 6). Bilateral lateral pontine hyperintensity was seen in six and two had “wine glass sign”. Ten patients died and the mortality correlated significantly with Glasgow coma score (P < 0.0001), degree of hypernatremia (P = 0.003), hyperchloremia (P = 0.002), hyperosmolarity (P = 0.01) at admission. At discharge, four patients recovered completely and the remaining improved gradually.
      Conclusion: Postpartum hypernatremia is a unique uncommon neurological emergency. Early detection and careful management of abnormal electrolytemia and azotemia results in good outcome.