Brain Neurorehabil.  2014 Sep;7(2):126-130. 10.12786/bn.2014.7.2.126.

Recovery from a Complicated Case of Central Pontine and Extrapontine Myelinolysis by Dopaminergic Treatment: One-Year Follow-up: A Case Report

• Seo YJ
• Im S
• Oh CH
• Park GY
• Ko SB
• Lee YJ

• KMID: 1797646
• DOI: http://doi.org/10.12786/bn.2014.7.2.126

Abstract

Central pontine and extrapontine myelinolysis are well-recognized osmotic demyelination syndromes related to the rapid correction of hyponatremia, chronic alcoholism, and malnutrition. They are reported to show brain stem signs and various movement disorders. A 58-year-old man with a history of chronic alcoholism was admitted for dysarthria, dysphagia, and gait disturbance that had developed five days after a right forearm cellulitis. Magnetic resonance imaging revealed demyelinating patterns in the central portion of the pons and both thalami. He showed severe extrapyramidal symptoms with truncal swaying and postural instability that resulted in severe gait disturbance. Postural instability showed little improvement after conventional physical therapy, but his symptoms markedly improved after five days of dopamine administration. Cessation of dopamine agents was attempted two times, but postural instability and gait disturbance recurred. Therefore, medication was continued for one year. The patient showed stable gait and no further deterioration of postural instability during dopamine therapy.

Keyword

central pontine myelinolysis; extrapyramidal syndrome; dopamine agents

MeSH Terms

Alcoholism
Brain Stem
Cellulitis
Deglutition Disorders
Demyelinating Diseases
Dopamine
Dopamine Agents
Dysarthria
Follow-Up Studies*
Forearm
Gait
Humans
Hyponatremia
Magnetic Resonance Imaging
Malnutrition
Middle Aged
Movement Disorders
Myelinolysis, Central Pontine*
Pons
Dopamine
Dopamine Agents

Figure

• 

  Fig. 1 Diffusion-weighted (DWI) (A) and T2-weighted (B) MRI show high signal intensity in the central portion of the pons and both thalami. Axial and sagittal T1-weighted (C) MRI show low signal intensity in the central portion of the pons and both thalami.

• 

  Fig. 2 (A) Patient with severe truncal ataxia. (B) Patient with improved postural stability after administration of levodopa/carbidopa (400/100 mg). (C) Patient with good recovery of mobility and balance to near premorbid levels with administration of levodopa/carbidopa (500/50 mg) at one-year follow-up in the outpatient clinic.

• 

  Fig. 3 Score changes in Berg's balance scale after levodopa/carbidopa administration and cessation.

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