Cerebellar ataxia with recovery related to central pontine myelinolysis

Abstract

Development of severe ataxia and mild pyramidal signs without mental deterioration, tetraparesis or pseudobulbar palsy during recovery from withdrawal delirium and initial hyponatraemia are unusual clinical features consistent with central pontine myelinolysis. This diagnosis was confirmed by magnetic resonance imaging (MRI) in an alcoholic man. Clinical and electrodiagnostic improvement occurred, whereas the MRI findings remained unchanged in a follow-up study.

Benign type of central pontine myelinolysis in alcoholism

“…Although truncal ataxia is not considered a characteristic feature of CPM, our findings suggest that truncal ataxia in alcoholics indicates the possibility of recent CPM. In fact, CPM accom- panied by cerebellar or sensory ataxia have been reported [4,6,8,11,16,22,27,31]. In contrast, none of our patients had the spastic paraparesis thought to be characteristic of CPM.…”

Reversible cerebellar ataxia: A rare presentation of depletional hyponatremia

“…Misra et al [1] reported two such patients with resolution of ataxia with correction of hyponatremia in 3 days and both of them had volume depletion as cause of hyponatremia. [6,7] In our patient, the cerebellar ataxia is most likely due to hyponatremia and it is possible that the cerebellar atrophy present premorbidly might have contributed to the clinical presentation. However, in both these case reports, MRI brain was not available but ataxia improved within a period of 3 to 7 days which is unlikely with CPM.…”

Central pontine myelinolysis

“…15 Well-documented reports describing a cerebellar syndrome as a presenting feature of CPM are rare. 16 Although our patient had preexisting atrophy of the vermis secondary to alcohol abuse, this was most likely an incidental finding because he had no prior symptoms, and acute dysarthria and appendicular ataxia are not features of degeneration of the vermis, which usually presents with chronic progressive gait ataxia.…”