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.

Introduction: Pulmonary hypertension is potentially fatal and courses with important day-today limitation. While the treatment is capable of slowing the disease's progression, increase in life expectancy is directly linked to early diagnosis and treatment. Objectives: To analyze the relation between alterations detectable on routine exams performed on pulmonary hypertension patients (echocardiography, electrocardiography and computerized tomography) and increases on pulmonary artery systolic pressure. Methods: We analyzed the recordings of patients presented with pulmonary hypertension, and separated them in two groups based on their echocardiography-estimated pulmonary artery systolic pressure. Group 1 was composed of patients with pulmonary artery systolic pressure between 35 mmHg and 65 mmHg, and Group 2 of patients with pulmonary artery systolic pressure > 65 mmHg. We analyzed the prevalence of alterations suggestive of pulmonary hypertension on echocardiography, electrocardiography and computerized tomography. A descriptive analysis of the findings was conducted, followed by comparative analysis between the groups. Results: We analyzed 101 patients (43 from Group 1 and 58 from Group 2). Most were women (82). Higher pulmonary artery systolic pressure values were correlated with right-heart dilation on echocardiography (p < 0.001). Electrocardiography findings revealed that right-heart hypertrophy and ventricular strain pattern were more common on Group 2 (p < 0.05). Computerized tomography analysis showed Group 2 patients had superior pulmonary artery diameters (p < 0.05). There was correlation between high pulmonary artery systolic pressure and clinical progression of the disease measured via the NYHA score (p < 0.05). Conclusion: It is possible to make use of clinical examination and a simple electrocardiography to stratify the severity of a pulmonary artery patient. Computerized tomography and echocardiography should be used to confirm these findings.

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