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Central pontine myelinolysis: delayed changes on neuroimaging
Summary
Rapid correction of hyponatremia can cause serious neurological damage, including central pontine myelinolysis. Repeat MRI scans are crucial for diagnosing this condition when initial imaging is normal.
Area of Science:
- Neurology
- Radiology
- Internal Medicine
Background:
- Hyponatremia, a condition of low serum sodium, can lead to significant neurological impairment.
- Rapid correction of electrolyte imbalances poses risks for neurological complications.
Observation:
- Two patients presented with altered mental status and hyponatremia.
- Initial neurological decline and quadriparesis occurred despite rapid serum sodium correction.
- Early MRI scans were unremarkable, failing to identify demyelinating lesions.
Findings:
- Repeat MRI scans 10-14 days later revealed central pontine myelinolysis and extrapontine demyelination.
- The clinical presentation and imaging findings confirmed hyponatremia correction as the cause of neurological illness.
Implications:
- Early MRI may not detect central pontine myelinolysis.
- A high index of suspicion and repeat imaging are essential for diagnosing central pontine myelinolysis.
- Delayed diagnosis of central pontine myelinolysis can result from unremarkable initial imaging.