Abstract Details

Title A Case of Spinal Cord Edema with Cord Compression Due to Systemic Lupus Erythematosus and Osmotic Shifts, Treated with Hypertonic Saline.

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-021

Objective Report a case of longitudinally extensive transverse myelitis in a 41 year-old woman with systemic lupus erythematous(SLE) treated with 3% saline.

Background Our patient was diagnosed with SLE 5 years prior during an episode of pericarditis with seizure and coma, followed by recovery without deficits. Two months before this hospitalization, she presented with C2-C6 myelitis that improved following high dose intravenous steroids. She was weaned to prednisone 10mg daily and maintained on mycophenolate mofetil 500mg twice daily. Later she was hospitalized for abdominal pain. Over four hospital days, she developed hypernatremia to serum sodium of 164mEq/L. On the 6th day she developed acute dyspnea (negative inspiratory force[NIF] -20cmH20) and increased weakness of all extremities. MRI revealed spinal cord edema causing cervical cord compression and T2 hyperintensity involving the entire cord. Additionally, her serum sodium had decreased from 164 to 150mEq/L over the preceding 24 hours. Her NIF declined further to -10cmH20 and she required urgent intubation.

Design/Methods Noting severe cord edema and recent osmotic shifts, we provided boluses of 3% hypertonic saline to achieve serum sodium of 155mEq/L while mycophenolate was continued and the patient was given 1000mg daily of intravenous methylprednisolone. Volumetric analysis of C2-T2 spinal levels quantified edema on serial MRIs.

Results She improved clinically by NIF (-42 cmH20) and arm strength contemporaneously with hypertonic saline. Repeat MRI showed persistent longitudinal T2 hyperintensity but resolved cord compression. Volumetric analysis of the two MRI scans supported improved cord edema (cord volume decreased from 15.97 to 9.85 cc3). This improvement allowed for extubation; however, she was subsequently reintubated for laryngeal edema and pneumonia ultimately requiring tracheostomy and gastrostomy placement.

Conclusions Acute serum sodium reduction is known to cause cerebral edema. This case suggests similar physiology may underlie spinal cord edema as a severe manifestation of inflammatory myelopathy.

Authors/Disclosures
Joshua Cahan, MD (Northwestern University, McGaw Medical Center) PRESENTER	No disclosure on file
Edward M. Manno, MD, FAAN (Northwestern Palos Hospital)	No disclosure on file
Eric Liotta, MD (Northwestern University)	Dr. Liotta has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Penumbra. The institution of Dr. Liotta has received research support from NIH-NINDS.

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