Pontine and extrapontine myelinolysis secondary to alcoholism: A case report.

Context: Osmotic demyelination syndrome (ODS) is rare, acute, severe and non-inflammatory. It is caused by the demyelination of neurons with the preservation of axons. It is called central pontine myelinolysis (CPM) when it affects the central pontine region and extra-pontine myelinolysis (EPM) when it affects other areas. Few cases of ODS due to non-electrolytic causes are reported. Case report: 54-year-old man with a history of heavy drinking. After about 24 hours of alcohol withdrawal, he developed generalized tonic-clonic seizures, associated with a lower level of consciousness. Protective orotracheal intubation was performed and the use of anti-crisis drugs was initiated. After sedation was switched off and mechanical ventilation was set to minimum parameters, the patient remained comatose and with convergence-retraction nystagmus movements. A skull MRI was performed, which showed lesions compatible with CPM and EPM. There was no variation in the patient’s plasma sodium during hospitalization. Conclusion: this is a patient with no evidence of any significant hydro-electrolyte disturbance and who presented a compatible neurological condition and neuroimaging characteristic of CPM / EPM. There is no specific clinical treatment for this pathology. Furthermore, the patient presents with the finding of convergence-retraction nystagmus, possibly explained by atrophy of the dorsal midbrain region.

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Atypical presentation of central pontine myelinolysis in hyperglycemia

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-17-0064 ◽

2017 ◽

Vol 2017 ◽

Cited By ~ 2

Author(s):

Swapna Talluri ◽

Raghu Charumathi ◽

Muhammad Khan ◽

Kerri Kissell

Keyword(s):

Case Report ◽

Blood Glucose ◽

Serum Sodium ◽

Central Pontine Myelinolysis ◽

Blood Glucose Control ◽

Clinical Suspicion ◽

Serum Osmolality ◽

Pontine Myelinolysis ◽

History Of ◽

Central Pontine

Summary Central pontine myelinolysis (CPM) usually occurs with rapid correction of severe chronic hyponatremia. Despite the pronounced fluctuations in serum osmolality, CPM is rarely seen in diabetics. This is a case report of CPM associated with hyperglycemia. A 45-year-old non-smoking and non-alcoholic African American male with past medical history of type 2 diabetes, hypertension, stage V chronic kidney disease and hypothyroidism presented with a two-week history of intermittent episodes of gait imbalance, slurred speech and inappropriate laughter. Physical examination including complete neurological assessment and fundoscopic examination were unremarkable. Laboratory evaluation was significant for serum sodium: 140 mmol/L, potassium: 3.9 mmol/L, serum glucose: 178 mg/dL and serum osmolality: 317 mosmol/kg. His ambulatory blood sugars fluctuated between 100 and 600 mg/dL in the six weeks prior to presentation, without any significant or rapid changes in his corrected serum sodium or other electrolyte levels. MRI brain demonstrated a symmetric lesion in the central pons with increased signal intensity on T2- and diffusion-weighted images. After neurological consultation and MRI confirmation, the patient was diagnosed with CPM secondary to hyperosmolar hyperglycemia. Eight-week follow-up with neurology was notable for near-complete resolution of symptoms. This case report highlights the importance of adequate blood glucose control in diabetics. Physicians should be aware of complications like CPM, which can present atypically in diabetics and is only diagnosed in the presence of a high index of clinical suspicion. Learning points: Despite the pronounced fluctuations in serum osmolality, central pontine myelinolysis (CPM) is rarely seen in diabetics. This case report of CPM associated with hyperglycemia highlights the importance of adequate blood glucose control in diabetics. Physicians should be aware of complications like CPM in diabetics. CPM can present atypically in diabetics and is only diagnosed in the presence of a high index of clinical suspicion.

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Central Pontine Myelinolysis after Liver Transplantation: A case report

Korean Journal of Anesthesiology ◽

10.4097/kjae.1997.33.3.572 ◽

1997 ◽

Vol 33 (3) ◽

pp. 572

Author(s):

Kwon Jae Lee ◽

Hyun Choi ◽

Young Joon Yoon ◽

Soo Tae Kim

Keyword(s):

Liver Transplantation ◽

Case Report ◽

Central Pontine Myelinolysis ◽

Pontine Myelinolysis ◽

Central Pontine

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Diffuse large B-cell lymphoma presenting with central pontine myelinolysis: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-015-0614-8 ◽

2015 ◽

Vol 9 (1) ◽

Cited By ~ 4

Author(s):

Eri Kawata ◽

Reiko Isa ◽

Junko Yamaguchi ◽

Kazuna Tanba ◽

Yasuhiko Tsutsumi ◽

...

Keyword(s):

Case Report ◽

B Cell ◽

Cell Lymphoma ◽

Central Pontine Myelinolysis ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Pontine Myelinolysis ◽

Central Pontine ◽

Large B Cell

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A Case of Central Pontine Myelinolysis Caused by Hypophosphatemia Secondary to Refeeding Syndrome

Case Reports in Neurology ◽

10.1159/000440711 ◽

2015 ◽

Vol 7 (3) ◽

pp. 196-203 ◽

Cited By ~ 4

Author(s):

Chikara Yamashita ◽

Hiroshi Shigeto ◽

Norihisa Maeda ◽

Takako Torii ◽

Yasumasa Ohyagi ◽

...

Keyword(s):

Serum Sodium ◽

Central Pontine Myelinolysis ◽

Rapid Change ◽

Serum Biochemistry ◽

Refeeding Syndrome ◽

Pontine Myelinolysis ◽

History Of ◽

Biochemistry Test ◽

Magnetic Resonance Imaging Mri ◽

Central Pontine

Central pontine myelinolysis (CPM), which was originally considered to be the result of rapid correction of chronic hyponatremia, is not necessarily accompanied by hyponatremia or drastic changes in serum sodium level. Here, we report a case of an anorexic 55-year-old male with a history of pharyngo-laryngo-esophagogastrectomy, initially hospitalized with status epilepticus. Although his consciousness gradually recovered as we were controlling his convulsion, it deteriorated again with new onset of anisocoria, and magnetic resonance imaging (MRI) at this point revealed CPM. Rapid change of serum sodium or osmolarity, which is often associated with CPM, had not been apparent throughout his hospitalization. Instead, a review of the serum biochemistry test results showed that serum phosphate had drastically declined the day before the MRI first detected CPM. In this case, we suspect that hypophosphatemia induced by refeeding syndrome greatly contributed to the occurrence of CPM.

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