"Man-in-the-barrel" syndrome as delayed manifestation of extrapontine and central pontine myelinolysis: beneficial effect of intravenous immunoglobulin.
"Man-in-the-barrel" syndrome has been rarely described following osmotic myelinolysis. We report a case of a 45-year-old woman admitted with septicemia and severe hyponatremia. She presented with a "man-in-the-barrel" syndrome which developed more than 10 days after rapid correction of the hyponatremia. There was radiological evidence of central pontine and extrapontine myelinolysis. Three days after completing a course of intravenous immunoglobulin therapy (0.4 g/kg body weight/day for 5 days) there was considerable improvement (Expanded Disability Status Scale score improved 30%). This case, reported for its peculiar mode of development, unusual presentation and challenging therapeutic response to intravenous immunoglobulin, highlights the enigmatic and unpredictable aspects of osmotic myelinolysis.
Department of Medicine (Neurology), Hamad Medical Corporation, P.O. Box 3050, Doha, State of Qatar. doc_deleu@hotmail.com
Dirk
D
Deleu
Khalid
K
Salim
Boulenouar
B
Mesraoua
Abbas
A
El Siddig
Hassan
H
Al Hail
Yolande
Y
Hanssens
D001132:Arm; D001921:Brain / Q000473:pathology; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000097:blood; D007116:Immunization, Passive; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017590:Myelinolysis, Central Pontine / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D010243:Paralysis / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D018805:Sepsis / Q000150:complications; D012964:Sodium / Q000097:blood; D014882:Water-Electrolyte Balance / Q000502:physiology
D016756:Immunoglobulins, Intravenous; D012964:Sodium