Objective: To be acquainted with the extrapyramidal symptoms developed during the course of central pontine myelinolysis. To emphasize the importance of neuroimaging in the diagnosis of CPM.

Background: Central pontine myelinolysis (CPM) as a unique clinical entity usually presents with spastic quadriplegia, pseudobulbar palsy, and varying degrees of encephalopathy or coma, this condition is associated with non-inflammatory demyelination involving the basis pontis. In some patients, demyelination also occurs in extrapontine regions, including the mid brain, thalamus, basal nuclei, and cerebellum yet rare cases described to develop extra pyramidal symptoms. Prognosis of CPM is usually unfavorable, however some rare cases showed complete recovery.

Methods: CASE PRESENTATION: We present a 54 years old female patient, with chronic hypertension and renal impairment presented at the emergency department with disturbed consciousness following serial fits. Her initial laboratory work up revealed hyponatraemia. Patient recovered completely after phenytoin loading, Sodium (Na) was corrected by normal saline over several days. On admission her neuroimaging was unremarkable. Five days following the onset, Patient experienced axial rigidity, bradykinesia , mask face and dystonic posturing of the upper limbs. With the onset of the new abnormal movements Computed Tomography (CT) brain was done and showed large area of hypointensity involving the central Pons (Fig. 1). Patient was investigated thoroughly to detect the cause of hyopnatraemia (Table. 1). Patient laboratory results showed anemia, hyopnatraemia, renal impairment, decrease plasma osmolality and increased urinary Na. Based on clinical and laboratory findings, the diagnosis of sodium losing nephropathy was established. Sodium was corrected appropriately and she was discharged home after 14 days of hospital admission with complete disappearance of the abnormal involuntary movements.

Results: Her laboratory work up revealed hyponatermia, serum Na = 110 mmol/L. Computed Tomography: large area of hypointensity involving the central Pons.

Conclusions: Parkinsonian features and dystonia can occur as reversible phenomena at the course of central pontine myelinolysis, recovery is the possible with when quickly and properly managed.

References: 1-Brown W. Osmotic demyelination disorders: central pontine and extrapontinemyelinolysis. Current Opinion in Neurology. 2000;13: 691-697. 2- Sajith J, DitchfieldA, Kalif HA. Extrapontine myelinolysis prsesnting as acute Parkinsonism. BMC Neurology. 2006; 6: 33. N.B. The abstract had been submitted and accepted at the Neuroimaging in Parkinson’s disease and Related Disorders Symposium. Calgary 2-10 June.2017.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/reversible-extrapyramidal-features-as-unusual-presentation-of-central-pontine-myelinolysis-a-case-report/