Neurogenic bladder due to hypoxic-ischemic demyelination

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. © 2008 by the American Society of Neuroimaging.