Background: Extrapontine myelinolysis (EPM) is rarely complicated with akinetic-rigid parkinsonism. Herein we report a case with EPM presenting with freezing of gait (FOG).

Methods: Case report: A 65 year-old female visited our clinic with a 10-day history of gait disturbance. She was a habitual drinker. She was hospitalized in a local hospital due to altered mental status, where she was diagnosed as metabolic encephalopathy and hyponatremia (103 mmol/L). Gait disturbance was noticed after recovery. Neurologic examination at admission to our hospital showed cognitive impairment, myoclonus in both upper limbs, dystonic posturing in right upper and lower extremities, generalized bradykinesia, postural instability and FOG. Brain MRI which was taken 3 days after onset of gait disturbance showed high signal intensities (HSIs) in both caudate nuclei (CN) and putamen and normal pons on T2 weighted images. Brain single photon emission tomography (SPECT) showed decreased perfusion in both basal ganglia (BG). L-dopa and methylphenidate was effective for her balance and gait problems. Follow-up MRI showed normalized CN and putamen, and HSIs on the pons. Follow-up SPECT showed improved perfusion in the both BG.

Conclusions: FOG was reversible along with the disappearance of HSIs in the striatum and partial improvement in perfusion to BG. As HSIs in the pons remained after the resolution of FOG, BG dysfunction was critical in the development of FOG.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/freezing-of-gait-in-extrapontine-myelinolysis/