Central pontine and extrapontine myelinolysis that developed during alcohol withdrawal, without hyponatremia, in a chronic alcoholic.
Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are osmotic demyelination syndrome. A 45-year-old man with a history of alcoholism visited the ER with dysarthria and dysphagia for 2 days. These symptoms occurred 3 days after he had stopped drinking alcohol. The neurological symptoms progressed to anarthria, pseudobulbar palsy and gait disturbance. During admission, the electrolyte studies were within the normal range. Diffusion-weighted images revealed high signal intensities in the pons, thalamus and basal ganglia. Apparent diffusion coefficient image showed low signal intensities in the pontine lesion, but isosignal intensities in the extrapontine lesion. The symptoms gradually improved after 1 month with only conservative treatment. The 1 month-follow-up MRI showed significant reduction of the previous extrapontine lesions. These findings suggest that cytotoxic edema is central to the pathogenesis of CPM, but vasogenic edema plays an important role in the pathogenesis of EPM occurring during alcohol withdrawal.
Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea. nrjyan@gmail.com
Jae Young
JY
An
Sung Kyung
SK
Park
Si Ryung
SR
Han
In Uk
IU
Song
D000437:Alcoholism / Q000150:complications* / Q000628:therapy; D004487:Edema / Q000150:complications; D000431:Ethanol / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017590:Myelinolysis, Central Pontine / Q000175:diagnosis / Q000209:etiology*; D011379:Prognosis; D013375:Substance Withdrawal Syndrome / Q000150:complications*
D000431:Ethanol