title: Parkinsonism after correction of hyponatremia with radiological central pontine myelinolysis and changes in the basal ganglia.
abstract: Parkinsonism has been rarely described following central pontine and extrapontine myelinolysis. We report a case of parkinsonism developing following rapid correction of hyponatremia with radiological evidence of central pontine myelinolysis and changes in the basal ganglia. A 56-year-old man developed drooling and bilateral hand tremors 3 weeks after correction of hyponatremia from 103 to 125 mmol/L over 14 h. He had a prominent 6 Hz resting tremor which worsened with action and mild cogwheel rigidity. Magnetic resonance imaging (MRI) showed changes consistent with central pontine myelinolysis and increased signal on T1-weighted images in the putamen bilaterally. His tremor responded well to L-dopa therapy. There have been several other cases of parkinsonism developing after central pontine/extrapontine myelinolysis. Increased signal in the basal ganglia on T1-weighted images has been described in another case of central pontine myelinolysis imaged about the same time after sodium correction as our case.
authors.affiliation: Department of Neurology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Sullivan
authors.forename: R D
authors.initials: RD
authors.lastname: Chervin
authors.forename: R L
authors.initials: RL
authors.lastname: Albin
mesh_terms: D000978:Antiparkinson Agents / Q000627:therapeutic use; D001479:Basal Ganglia / Q000473:pathology*; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D007010:Hyponatremia / Q000150:complications / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017590:Myelinolysis, Central Pontine / Q000209:etiology* / Q000473:pathology; D020734:Parkinsonian Disorders / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology
chemical_list: D000978:Antiparkinson Agents