Korean J Neurotrauma.  2014 Apr;10(1):31-34. 10.13004/kjnt.2014.10.1.31.

Central Pontine and Extrapontine Myelinolysis in a Patient with Traumatic Brain Injury Following Not Rapid Correction of Hyponatremia: A Case Report

• Baek TH
• Yang SH
• Sung JH
• Lee SW

• KMID: 2156095
• DOI: http://doi.org/10.13004/kjnt.2014.10.1.31

Abstract

Central pontine myelinolysis occurs inconsistently as a complication of severe and prolonged hyponatremia, particularly when corrected too rapidly. This condition is a concentrated, frequently symmetric, noninflammatory demyelination within the central basis pontis. We describe a head injury patient who developed central pontine and extrapontine myelinolysis following a gradual correction of hyponatremia. More attention should be paid to correcting hyponatremia combined with hypokalemia in patients who have a history of alcoholism.

Keyword

Central pontine myelinolysis; Hyponatremia; Head injury; Hypokalemia

MeSH Terms

Alcoholism
Brain Injuries*
Craniocerebral Trauma
Demyelinating Diseases
Humans
Hypokalemia
Hyponatremia*
Myelinolysis, Central Pontine*

Figure

• 

  FIGURE 1 Brain CT scan showing an epidural hematoma and contusion in the right temporal region.

• 

  FIGURE 2 Brain MR T2 images showing multiple contusions in the right temporal (A) and left frontal regions (B).

• 

  FIGURE 3 Diffusion-weighted image (A) showing high signal intensity with decreased ADC value (B) in both pons, the thalamus, and frontoparietal cortex (arrows). These lesions (asterisks) show high signal intensity on T2-weighted axial images (C). ADC: apparent diffusion coefficient.

• 

  FIGURE 4 Daily levels of serum sodium and potassium.

Reference

1. Abbott R, Silber E, Felber J, Ekpo E. Osmotic demyelination syndrome. BMJ. 2005; 331:829–830. PMID: 16210283.

2. de Souza A. Akinetic-rigid syndrome due to extrapontine and pontine myelinolysis following appropriate correction of hyponatraemia. J Clin Neurosci. 2011; 18:587–589. PMID: 21273078.

3. Lohr JW. Osmotic demyelination syndrome following correction of hyponatremia: association with hypokalemia. Am J Med. 1994; 96:408–413. PMID: 8192171.

4. Martin RJ. Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes. J Neurol Neurosurg Psychiatry. 2004; 75(Suppl 3):iii22–iii28. PMID: 15316041.

5. Menger H, Jörg J. Outcome of central pontine and extrapontine myelinolysis (n=44). J Neurol. 1999; 246:700–705. PMID: 10460448.

6. Miller GM, Baker HL Jr, Okazaki H, Whisnant JP. Central pontine myelinolysis and its imitators: MR findings. Radiology. 1988; 168:795–802. PMID: 3406409.

7. Musana AK, Yale SH. Central pontine myelinolysis: case series and review. WMJ. 2005; 104:56–60. PMID: 16218318.

8. Pradhan S, Jha R, Singh MN, Gupta S, Phadke RV, Kher V. Central pontine myelinolysis following 'slow' correction of hyponatremia. Clin Neurol Neurosurg. 1995; 97:340–343. PMID: 8599905.

9. Razvi SS, Leach JP. Asymptomatic pontine myelinolysis. Eur J Neurol. 2006; 13:1261–1263. PMID: 17038043.

10. Sajith J, Ditchfield A, Katifi HA. Extrapontine myelinolysis presenting as acute parkinsonism. BMC Neurol. 2006; 6:33. PMID: 16961933.

11. Schaefer PW, Grant PE, Gonzalez RG. Diffusion-weighted MR imaging of the brain. Radiology. 2000; 217:331–345. PMID: 11058626.

12. Singh DK, Rastogi M, Husain M. Central pontine myelinolysis in a pediatric head injury patient. Pediatr Neurosurg. 2010; 46:51–53. PMID: 20516740.

13. Wright DG, Laureno R, Victor M. Pontine and extrapontine myelinolysis. Brain. 1979; 102:361–385. PMID: 455045.

14. Yuh WT, Simonson TM, D'Alessandro MP, Smith KS, Hunsicker LG. Temporal changes of MR findings in central pontine myelinolysis. AJNR Am J Neuroradiol. 1995; 16(4 Suppl):975–977. PMID: 7611089.