Reversible parkinsonism in central pontine and extrapontine myelinolysis: A report of five cases from India and review of the literature

Parkinsonism with or without dystonia has been rarely described following central pontine myelinolysis and extrapontine myelinolysis. We report 5 cases of reversible parkinsonism and dystonia with imaging evidences of central pontine myelinolysis and extrapontine myelinolysis associated with hyponatremia from a center in Eastern India. Their presentations varied from mild masked facies to extra pyramidal syndromes characterized by progressive supranuclear palsy like feature and marked dystonia. Two cases presented with flaccid quadriplegia later evolved into spasticity and dystonia. The cause of hyponatremia was due to vomiting in two, diuretic-induced, nutritional and psychogenic polydipsia one each. The onset was acute in 4, and gradual in one from psychogenic polydipsia. They responded well to gradual correction of electrolyte imbalance, dopaminergic and antidystonic agents including botulinum toxin. The movement disorders of central pontine myelinolysis with extrapontine myelinolysis represent a treatable manifestationof the osmotic demyelination syndrome and rewarding result can be achieved.

Large plexiform neurofibroma: unusual cause for blindness

Plexiform neurofibroma presents anywhere along the course of nerves usually trigeminal nerve. Unilateral amblyopia is caused due to retinal deprivation of sensory sensation. In our case large size of neurofibroma hanging from the supraorbital ridge acted as a curtain for the eye depriving it from sensory stimulation before the age of fixation of response of brain to light, leading to complete blindness