A case of extrapontine myelinolysis in patient with Sheehan's syndrome

Lee, Seong Jin; Park, Hyung Joo; Han, Jung Hee; Kim, Seung Kyu; Kim, Young Il; Kim, Chul Hee; Hong, Sung Kwan; Kim, Ghi Su

Abstract

Since the first descriptions of central pontine myelinolysis(CPM) were put forth it has become evident that myelinolysis may not be exclusively restricted to the pons. In many cases myelinolysis may share other brain regions, while in still others the pons may not be affected at all as in the present case of pure basal ganglia myelinolysis. Regardless of geographic location, too rapid correction of hyponatremia has been invoked as the triggering mechanism which leads to both CPM and extrapontine myelinolysis(EPM).This case of EPM is that a 51-year-old female who was healthy. Following vomiting and poor oral intake, a low serum sodium(110 mEq/L) developed and was corrected to normal(140 mEq/L) within 36 hours. Seven days later altered mental status ensued and the patient was transferred to our hospital. Clinical manifestation and hormonal study were compatible with panhypopituitarism (Sheehan's syndrome). T2 weighted MRI showed symmetrical, bilateral high intensity foci in the putamen, caudate nucleus. The pons was spared. This case illustrates that extrapontine, basal ganglia myelinolysis may occur in the absence of CPM or alternate areas of myelinolysis. MRI is uncovering many new cases in EPM and CPM. This permits one to follow the evolution of the myelinolytic lesions and to correlate their progression or regression with treatment modalities and the neurological findings.