Neurogenic Bladder Due to Hypoxic-Ischemic Demyelination

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1552-6569.2007.00167.x Byline: Sindhu Ramchandren (1), David S. Liebeskind (1) Keywords: Hypoxia; ischemia; demyelination; neurogenic bladder; Wallerian degeneration Abstract: ABSTRACT BACKGROUND AND PURPOSE Hypoxia is commonly known to target neuronal cell bodies. Although myelin is a non-infrequent target, posthypoxic demyelination is a rarely described entity. We describe the case of a man who developed neurogenic bladder following a motor vehicle accident. CASE REPORT Following a severe motor-vehicle accident involving massive blood loss, a 46-year-old man developed urinary urgency requiring catheterization, with hyperactive reflexes and bilateral Babinski signs on exam. RESULTS Magnetic resonance imaging of the brain and cervical cord revealed diffuse, isolated white matter signal abnormality in a symmetric, confluent distribution, extending inferiorly into the spinal cord, with changes consistent with bilateral Wallerian degeneration. Serologic and CSF evaluations were normal. CONCLUSIONS Unlike previous reports of hypoxic-ischemic demyelination, our patient lacked any cortical abnormalities, presumably due to isolated white matter changes. This report alerts physicians to the possibility of hypoxic-ischemic demyelination due to global hypoxia-ischemia as an etiologic factor for neurogenic bladder. Author Affiliation: (1)University of Michigan Health System, Neurology, Ann Arbor, MI (SR); and UCLA Stroke Center-University of California, Los Angeles, CA (DSL). Article History: Acceptance: Received October 6, 2006, and in revised form May 24, 2007. Accepted for publication June 18, 2007. Article note: Correspondence: Address correspondence to Sindhu Ramchandren, MD, Department of Neurology, University of Michigan at Ann Arbor, 300 North Ingalls St, #3D06, Ann Arbor, MI 48109. E-mail: sindhur@med.umich.edu.