低ナトリウム血症の急速な補正後に発症したcentralpontine and extra-pontine myelinolysisの1剖検例

CENTRAL PONTINE AND EXTRA-PONTINE MYELINOLYSIS FOLLOWING RAPID CORRECTION OF HYPONATREMIA: A CASE REPORT

　抄録　低ナトリウム血症の急速な補正後に発症したcentral pontine and extra-pontine myelinolysisの1剖検例を報告した。患者は死亡時51歳の女性。結核による慢性副腎機能不全により低ナトリウム血症が惹起され，この高度の低ナトリウム血症〔100mEq／l〕を高張の食塩水にて急速に補正した。補正後一時的に意識レベルは回復し，呼名反応もみられるようになったが，補正後2日目には症状悪化し，約1ヵ月後に肺炎にて死亡した。剖検では橋前底部に中心性の広範な病変がみられ，central pontine myelinolysisの組織像に一致した。同様の病変は大脳皮質や皮質下諸核にも広範に分布していた。灰白質中を走る細い有髄線維束が選択的に侵される傾向が窺えた。この疾患の病因論につき若干の考察をくわえた。

An autopsy case of central pontine and extra-pontine myelinolysis following rapid correction of hyponatremia is reported. Hyponatremia was indu-ced by massive devastation of adrenal cortex due to tuberculosis. Severe hyponatremia (approxima-tely 100 mEq/l of serum sodium level) was rapidly corrected by infusion of hypertonic saline solution within two days. After transient regression of her consciousness, the patient developed decorti-cated state and then complete paralysis of all limbs. She died of pneumonia approximately one month after the last illness. The autopsy reveal-ed myelynolysis in the center of the pontine basis. The nerve cells and axon cylinders were relatively well preserved. In addition, the similar lesions were seen in the subcortical gray matter and cerebral cortex. The thin white matter at the site characterized by an extensive admixture of gray and white matter was selectively involved. The pathogenesis of this disorder is briefly discussed.