Central pontine myelinolysis – a case report

Abstract

Central pontine myelinolysis (CPM) is an acute non-inflamatory demyelinating disease, localized to the central- pontine region, which is associated to a clinical picture of flaccid tetraparesis, pseudo-bulbar paralysis and different degrees of encephalopathy or coma. The etiology is yet to be totally cleared, but it is generally associated to electrolyte unbalances, mainly severe hyponatremia and its rapid correction. The imagiologic diagnostic confirmation can be done through brain magnetic resonance imaging (MRI).

This is a report of the case of a 42 year old woman, with previous history of psychiatric disturbances and heavy alcohol consumption, admitted to hospital after a fall, and presenting with jaundice, weight loss and prostration, which had been present for nearly 3 weeks. Hyponatremia was identified and corrected, after which, the patient developed tetraparesis and generalized hypotonia. The brain MRI was compatible with the diagnosis of CPM.

The patient was admitted to a Rehabilitation Center 8 weeks after. She began her intensive, multimodal rehabilitation program, and she had a positive result during the 10 week inpatient treatment period.

CPM is a rare condition, without an established treatment, which can have a poor prognosis, both from a vital and a functional perspective. The early initiation of an intensive and comprehensive rehabilitation program is fundamental to the final results, regarding the integration of these people.

Keywords: Myelinolysis; Central Pontine; Hyponatremia; Quadriplegia; Rehabilitation.