Parkinsonism after correction of hyponatremia with radiological central pontine myelinolysis and changes in the basal ganglia.
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.
Sullivan
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AA
Department of Neurology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
Chervin
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RD
Albin
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RL
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
D000978:Antiparkinson Agents