Ann Rehabil Med.  2017 Feb;41(1):148-152. 10.5535/arm.2017.41.1.148.

Central Pontine Myelinolysis Induced by Alcohol Withdrawal: A Case Report

• Kim JH
• Kim SH
• Jeong HJ
• Sim YJ
• Kim DK
• Kim GC

• KMID: 2383689
• DOI: http://doi.org/10.5535/arm.2017.41.1.148

Abstract

Central pontine myelinolysis (CPM) is a demyelinating disorder characterized by the loss of myelin in the center of the basis pons, and is mainly caused by the rapid correction of hyponatremia. We report the case of a young woman who presented with gait disturbance and alcohol withdrawal, and who was eventually diagnosed with CPM. Generally, the cause and pathogenesis of CPM in chronic alcoholics remain unclear. In this cases, the CPM may be unrelated to hyponatremia or its correction. However, it is possible that the osmotic pressure changes due to refeeding syndrome after alcohol withdrawal was the likely cause in this case. This case illustrates the need for avoiding hasty, and possibly incomplete diagnoses, and performing more intensive test procedures to ensure a correct diagnosis.

Keyword

Central pontine myelinolysis; Alcohol withdrawal

MeSH Terms

Alcoholics
Demyelinating Diseases
Diagnosis
Female
Gait
Humans
Hyponatremia
Myelin Sheath
Myelinolysis, Central Pontine*
Osmotic Pressure
Pons
Refeeding Syndrome

Figure

• 

  Fig. 1 Brain magnetic resonance imaging (MRI) scan at the level of the pons: T2 FLAIR image (A), T2-weighted image (B), and T2-weighted sagittal image (C). MRI scan demonstrates an ill-defined, patchy, trident-shaped, mild high signal intensity lesion in the pons (arrow). Otherwise, no significant focal lesions were noted.

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