Acute Psychosis as Main Manifestation of Central Pontine Myelinolysis
Central pontine myelinolysis (CPM) is an acute demyelinating neurological disorder affecting primarily the central pons and is frequently associated with rapid correction of hyponatremia. Common clinical manifestations of CPM include spastic quadriparesis, dysarthria, pseudobulbar palsy, and encepha...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Case Reports in Neurological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2017/1471096 |
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| author | Mangala Gopal Melvin Parasram Harsh Patel Chike Ilorah Hrachya Nersesyan |
| author_facet | Mangala Gopal Melvin Parasram Harsh Patel Chike Ilorah Hrachya Nersesyan |
| author_sort | Mangala Gopal |
| collection | DOAJ |
| description | Central pontine myelinolysis (CPM) is an acute demyelinating neurological disorder affecting primarily the central pons and is frequently associated with rapid correction of hyponatremia. Common clinical manifestations of CPM include spastic quadriparesis, dysarthria, pseudobulbar palsy, and encephalopathy of various degrees; however, coma, “locked-in” syndrome, or death can occur in most severe cases. Rarely, CPM presents with neuropsychiatric manifestations, such as personality changes, acute psychosis, paranoia, hallucinations, or catatonia, typically associated with additional injury to the brain, described as extrapontine myelinolysis (EPM). We present a patient with primarily neuropsychiatric manifestations of CPM, in the absence of focal neurologic deficits or radiographic extrapontine involvement. A 51-year-old female without significant medical history presented with dizziness, frequent falls, diarrhea, generalized weakness, and weight loss. Physical examination showed no focal neurological deficits. Laboratory data showed severe hyponatremia, which was corrected rather rapidly. Subsequently, the patient developed symptoms of an acute psychotic illness. Initial brain magnetic resonance imaging (MRI) was unremarkable, although a repeat MRI two weeks later revealed changes compatible with CPM. This case demonstrates that acute psychosis might represent the main manifestation of CPM, especially in early stages of the disease, which should be taken into consideration when assessing patients with acute abnormalities of sodium metabolism. |
| format | Article |
| id | doaj-art-4b7edba975344596888872c4f712e233 |
| institution | OA Journals |
| issn | 2090-6668 2090-6676 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Neurological Medicine |
| spelling | doaj-art-4b7edba975344596888872c4f712e2332025-08-20T02:38:35ZengWileyCase Reports in Neurological Medicine2090-66682090-66762017-01-01201710.1155/2017/14710961471096Acute Psychosis as Main Manifestation of Central Pontine MyelinolysisMangala Gopal0Melvin Parasram1Harsh Patel2Chike Ilorah3Hrachya Nersesyan4College of Osteopathic Medicine, Des Moines University, Des Moines, IA, USAArizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USABaroda Medical College, Vadodara, Gujarat, IndiaDepartment of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, USADepartment of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, USACentral pontine myelinolysis (CPM) is an acute demyelinating neurological disorder affecting primarily the central pons and is frequently associated with rapid correction of hyponatremia. Common clinical manifestations of CPM include spastic quadriparesis, dysarthria, pseudobulbar palsy, and encephalopathy of various degrees; however, coma, “locked-in” syndrome, or death can occur in most severe cases. Rarely, CPM presents with neuropsychiatric manifestations, such as personality changes, acute psychosis, paranoia, hallucinations, or catatonia, typically associated with additional injury to the brain, described as extrapontine myelinolysis (EPM). We present a patient with primarily neuropsychiatric manifestations of CPM, in the absence of focal neurologic deficits or radiographic extrapontine involvement. A 51-year-old female without significant medical history presented with dizziness, frequent falls, diarrhea, generalized weakness, and weight loss. Physical examination showed no focal neurological deficits. Laboratory data showed severe hyponatremia, which was corrected rather rapidly. Subsequently, the patient developed symptoms of an acute psychotic illness. Initial brain magnetic resonance imaging (MRI) was unremarkable, although a repeat MRI two weeks later revealed changes compatible with CPM. This case demonstrates that acute psychosis might represent the main manifestation of CPM, especially in early stages of the disease, which should be taken into consideration when assessing patients with acute abnormalities of sodium metabolism.http://dx.doi.org/10.1155/2017/1471096 |
| spellingShingle | Mangala Gopal Melvin Parasram Harsh Patel Chike Ilorah Hrachya Nersesyan Acute Psychosis as Main Manifestation of Central Pontine Myelinolysis Case Reports in Neurological Medicine |
| title | Acute Psychosis as Main Manifestation of Central Pontine Myelinolysis |
| title_full | Acute Psychosis as Main Manifestation of Central Pontine Myelinolysis |
| title_fullStr | Acute Psychosis as Main Manifestation of Central Pontine Myelinolysis |
| title_full_unstemmed | Acute Psychosis as Main Manifestation of Central Pontine Myelinolysis |
| title_short | Acute Psychosis as Main Manifestation of Central Pontine Myelinolysis |
| title_sort | acute psychosis as main manifestation of central pontine myelinolysis |
| url | http://dx.doi.org/10.1155/2017/1471096 |
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