Rapid development of central pontine myelinolysis after recovery from Wernicke encephalopathy: a non-alcoholic case without hyponatremia.
We describe a non-alcoholic diabetic patient with central pontine myelinolysis (CPM) and Wernicke encephalopathy (WE). A 69-year-old man developed consciousness disturbance after parenteral hyperalimentation for liver abscess and sepsis. Neurological examination revealed drowsiness and no articulation. MRI disclosed T2-hyperintense lesions in the dorsal medulla oblongata and dentate nuclei, and symmetric enhancement in the inferior colliculus. Thiamine treatment (1,000 mg/day, div) attenuated neurological deficits. Seven days later, WE-related lesions were markedly regressed and a central pontine T2-hyperintensity lesion appeared. Serum sodium levels were normal. Physicians should pay more attention to rapid development of normonatremic CPM under thiamine supplementation in non-alcoholic WE patients.
Department of Gastroenterology, Toho University Omori Medical Center, Japan.
Yuui
Y
Kishimoto
Ken
K
Ikeda
Kiyoko
K
Murata
Kiyokazu
K
Kawabe
Takehisa
T
Hirayama
Yasuo
Y
Iwasaki
D000368:Aged; D001921:Brain / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D017590:Myelinolysis, Central Pontine / Q000175:diagnosis / Q000209:etiology*; D012964:Sodium / Q000097:blood; D013831:Thiamine / Q000009:adverse effects*; D013997:Time Factors; D014899:Wernicke Encephalopathy / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*
D012964:Sodium; D013831:Thiamine