Osmotic Demyelination Syndrome (Central Pontine and Extrapontine Myelinolysis with Coagulative Necrosis of the Putamina and Cortical Laminar Necrosis)

Abstract

Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are disorders frequently associated with serum osmotic imbalance. The prognosis is very variable from complete regression of clinical symptomatology to signs of significant quadruparesis, a vegetative state and death. We report the case of a 25-year-old man with a diagnosis of osmotic demyelination syndrome. The patient was young healthy man with no history of chronic alcoholism or malnutrition. He underwent head trauma associated with consumption of alcohol, being diagnosed with cerebral commotion. Four days later he presented with generalised epileptic convulsions with unconsciousness. Laboratory findings showed significant hyponatremia and hypochlorinemia. Following the rapid correction of osmotic conditions of serum, spastic quadruparesis and coma developed. MRI of the brain showed finding of CPM and EPM, cortical laminar necrosis (CLN) and coagulative necrosis in the putamina. Our case is suggestive in the rare MRI appearance of myelinolysis in addition to CLN and coagulative necrosis in the basal ganglia following the rapid correction of serum osmolarity. We suggest that this finding is prognostically very unfavourable. In the reported patient clinically initial neurological deficit progressed to a vegetative state within one month.