Complete reversibility of central pontine myelinolysis not associated with hyponatremia

Abstract

Background: Central pontine myelinolysis (CPM) is a demyelinating disorder most frequently described in alcoholism and malnourishment after rapid correction of hyponatremia affecting the pontine base. We present a case of reversible CPM as demonstrated on neuroimaging and at autopsy in a patient with recent upper respiratory infection and vitamin B12 deficiency. Case persentation: Patient presented with lower extremity weakness after upper respiratory infection. She had a normal sodium level, but found to have low vitamin B12 level. MRI of the brain showed restricted diffusion in the pontine basis. She was given empiric prednisone for myopathic symptoms and vitamin B12 supplementation for her low level. She made full clinical recovery by 5 months. She developed pneumonia 6 months after initial presentation. Repeat MRI showed resolution of the hyperintensity in the pontine basis. Her respiratory status worsened, and she died. At autopsy, there was no evidence of demyelination in the pontine basis. Conclusion:The importance of this case is that in CPM not associated with hyponatremia the radiologicalpathological correlation of osmotic demyelination can be completely reversible.