A Case of Central Pontine Myelinolysis due to Severe Acute Prolonged Hyponatremia in Our County Hospital

Abstract

Background: Central pontine myelinolysis (CPM)is unique and rare clinical entity. It could be a neurological complication of prolonged hyponatraemia. Many predisposing risk factors (chronic alcoholism, malnutrition, malignancy) may aggravate the development of CPM. CPM usually have a poor or even fatal outcome. However, CPM does not inevitably have a bad prognosis, and could occur with proper restoration of normal serum sodium concentrations. Case Summary: Here, we presented a case of a 48-year-oldfemale. She used to drink alcohol. She presented to Our Lady’s Hospital/Navan with a history of four days feeling unwell, confused diarrhea, vomiting and by investigations, she had severe hyponatraemia. She was managed optimally in the ICU with close monitoring of her urea and electrolytes. Unfortunately, she got progressive neurological deficits (lower limbs weakness, and slurred speech) irrespective of gentle treatment of hyponatremia in intensive care unit. After Neurological and radiological input from Dublin institute, CPM confirmed under background of alcoholism and malnutrition. Following the diagnosis of CPM, she was discharged home after been rehabilitated with physiotherapy with ongoing recovery.

Keywords

• hyponatremia
• central pontine myelinolysis
• alcoholism
• malnutrition