A case of
central pontine myelinolysis (CPM) following rapid correction of
hyponatremia is reported and a review of the literature is made. The patient was a 63-year-old non-alcoholic female who had no liver or
kidney diseases in her past history. She was found unconscious after a series of convulsions and was admitted to the hospital. Eighteen months prior to admission, she had a surgery for a ruptured
anterior communicating artery aneurysm. Her postoperative course was uneventful except for an
urinary incontinence and mild disorientation. She was initially lethargic with conjugate deviation toward right. Nine days after admission, she still remained lethargic, and laboratory studies showed a serum
sodium value of 93 mEq/l, serum osmolarity 206 mOsm/l and urine osmolarity 270 mOsm/l when she was clinically diagnosed as having
SIADH. She was treated by a strict elimination of water, and administration of
sodium,
dexamethasone and
demeclocycline. In three days, serum
sodium was corrected and returned to 137 mEq/l. However, she deteriorated in consciousness and became
comatose and developed
quadriplegia. CT scans and cerebral angiograms were normal. One month later, another CT scans demonstrated a well-defined hypodensity area in the pons. Brain stem auditory response (BSAR) showed a prolongation of III-V interpeak latency, especially IV-V interval. Her neurological state was essentially unchanged thereafter and she died of
septic shock after 12 months' hospitalization. No permission for autopsy was obtained. The
clinical course, CT scans and BSAR reported here are indicative of the diagnosis of CPM.