Rapid Correction of Hyponatremia With Isotonic Saline Leading to Central Pontine Myelinolysis

Abstract

Central pontine myelinolysis (CPM) is a part of the spectrum of osmotic demyelination syndrome (ODS), which is a rare demyelinating disorder due to the rapid correction of low serum sodium. It affects the neurons of the pons but may also involve other extra-pontine sites. The disease is characterized by a wide variety of clinical features ranging from dysarthria, dysphagia, bulbar palsy, quadriplegia, and behavioral and psychiatric disturbances. We present a case of a young female who developed CPM due to rapid sodium correction after vomiting. She presented with quadriplegia and locked-in syndrome. The diagnosis is on the basis of clinical and radiographic features. Magnetic resonance imaging (MRI) of the brain is superior to computed tomography (CT) in detecting changes. It shows hyperintensities on T2-weighted images that are classically known as the trident sign in the region of the pons. The patient was managed supportively, and the family was counseled regarding the poor prognosis of the disease. Unfortunately, she met a fatal fate due to a complication of CPM that is aspiration pneumonia. It is, therefore, imperative to create more awareness regarding the disease, and measures should be taken for its prevention that includes correction of low sodium levels not greater than 10 mmol/L/day.

A Case of Alcohol Withdrawal-Induced Central and Extrapontine Myelinolysis

“…ODS manifests with a variety of clinical presentations, including altered consciousness/encephalopathy, dysphagia, and limb weakness [2]. The underlying cause and pathogenesis of ODS remain unclear; however, numerous studies have implicated the rapid correction of hyponatremia as the primary factor associated with CPM, resulting in damage to specific brain regions, particularly the pontine white matter tracts [3]. Although other causes have been suggested, a limited number of cases have reported an association between ODS and alcohol withdrawal.…”