Extra Pontine Myelinolysis without Striatal involvement Presenting as Pathological Crying, Reversible Parkinsonism and Dystonia.

A case of Central Pontine Myelinolysis and Extrapontine Myelinolysis presented with dystonia, Parkinsonism, and pathological crying that developed few days after gradual correction of hyponatremia. EEG slowing was evident before onset of symptoms, and disappeared with clinical improvement. Thalamic lesions alone produced these features. It dramatically responded to the Trihexyphenidyl therapy. Thus, basal ganglia involvement is not mandatory to produce this clinical picture; early onset of symptoms, resolution of EEG slowing and prompt response to anticholinergics may indicate better prognosis.

Mielinolisis central pontina inducida por hiperemesis gravidica / Central pontine myelinolysis induced by hyperemesis gravidarum

Presentamos a un paciente de sexo feminino, de 18 años, primigesta, con hiperemesis gravídica, deshidratada, que no presentaba hiponatremia. La paciente desarolló nistagmus multidireccional, desorientación temporoesdpacial, apatía y marcha atáxica luego de la admisión al hospital; cuadro compatible con encefalopatía de wernicke. El laboratorio demostraba hipocaliemia, hipernatremia y aumento de las aminotransferasas. La osmolaridad plasmática calculada fue 319 mOsm/Kg y el déficit de agua de 2.73 I. Evolucionó con pérdida de la fuerza en cuatro miembros, hipotoncidad, reflejos tendinosos ausentes y signo de Babinski bilateral. En la resonancia magnética nuclear de cerebro se observaba, en cortes sagitales, una imagen hiperintensa en T2 a nivel pontino y en cortes axiales una banda central hipointensa en T1 sugestivas de mielinolisis central pontina. En el caso de nuestra paciente la mielinosis central pontina probablemente resulta secundaria a la asociación de: hipernatremia, hipersomolaridad de hipocaliemia.

Mielinolisis póntica central con síndrome de enclaustramiento

Tha case of a 55 year old man who presented with severe global headache 8 hours after having been drinking heavily, and who over a two hour period developed deep coma and flaccid paralysis of all four extremities is reported. A CT scan of the brain was normal; however, on Magnetic Resonance Imaging (MRI) extensive hyperintense areas in the brain stem, mainly in the pons, were easily identified. Based upon the clinical and MRI findings a diagnosis of Central Pontine Myelinolysis was made. Following several months of supportive therapy the patient partially recovered and was able to leave the hospital.