Pontine and extrapontine myelinolysis.

Humberto Marreiros, Rui Santos, Susana Santos, Rita Tomás, Alexandra Marques, Eugénia Veiga


INTRODUCTION: Myelinolysis is defined as acute demyelinating disorder, associated with flaccid quadriplegia, speech and swallowing impairment. The pathogenesis is usually related to hydroelectrolytic imbalance, particularly with severe hyponatremia and its rapid correction. The imagiologic diagnostic is commonly done by magnetic resonance imaging. AIM: The authors present a clinical case focusing on the follow up, rehabilitation program, and giving importance to functionality gains. The main clinical intercurrences related to the late diagnosis are also reported. CLINICAL CASE: A female patient with documented past psychiatric history and polidipsia was admitted with repeated seizures unsuccessfully controlled by drugs. Hyponatremia was identified and corrected. After the correction, a quadriplegia and a generalized hypotonia were noticed and the patient underwent magnetic resonance imaging. The imaging findings were consistent with the diagnosis of central pontine and extrapontine myelinolysis.

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