Korean J Nephrol.  2006 Mar;25(2):327-331.

A Case of Central Pontine and Extrapontine Myelinolysis in a Patient with Maintenance Hemodialysis

• Jang SW
• Kim IY
• Kim JH
• Song SH
• Lee DW
• Lee SB
• Lee SJ
• Kwak IS

Abstract

Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) is a rare syndrome that is clinically characterized by quadriparesis, pseudobulbar palsy, and disturbance of consciousness. It commonly occurs in patients with rapid correction of hyponatremia and chronic alcoholism. We report a case of CPM and EPM in a 55-year-old male patient with maintenance hemodialysis. He had type 2 diabetes mellitus for more than 20 years and underwent hemodialysis for the past 7 months. He was admitted for left periorbital cellulitis and uremic symptoms. On the 34th hospital day, he had nausea, vomiting, decreased consciousness, dysarthria and quadriparesis. Laboratory data were revealed as follows:glucose, 117 mg/dL; sodium, 137.1 mEq/L; and serum osmolality, 277 mosm/L. Magnetic resonance imaging (MRI) of the brain revealed increased signal intensity in the pons, upper medulla, cerebellar peduncle and cerebral peduncle in T2 weighted images. This case was considered as primary CPM and EPM occurring in a patient with maintenance hemodialysis. With general supportive care, the patient has been recovered gradually and is being followed up on an outpatient basis.

Keyword

Myelinolysis; Central pontine; Renal dialysis; Magnetic resonance imaging

MeSH Terms

Alcoholism
Brain
Cellulitis
Consciousness
Diabetes Mellitus, Type 2
Dysarthria
Humans
Hyponatremia
Magnetic Resonance Imaging
Male
Middle Aged
Myelinolysis, Central Pontine*
Nausea
Osmolar Concentration
Outpatients
Pons
Pseudobulbar Palsy
Quadriplegia
Renal Dialysis*
Sodium
Tegmentum Mesencephali
Vomiting
Sodium