[Clinical course and evolution of lesion in MRI in central pontine myelinolysis in a patient abusing alcohol]

Area of Science:

• Neurology
• Neuroimaging
• Toxicology

Background:

• Alcohol abuse is a significant risk factor for various neurological disorders.
• Organic brain syndromes can manifest with diverse neurological deficits.
• Central pontine myelinolysis (CPM) is a demyelinating disease typically associated with electrolyte imbalances.

Observation:

• A 44-year-old patient with a decade of alcohol abuse presented with cerebellar ataxia, hemiparesis, and bulbar symptoms.
• Brain MRI revealed a hyperintense lesion in the central pons on T2-weighted images, indicative of CPM.
• Notably, the patient did not exhibit hyponatremia at the time of diagnosis.

Findings:

• Despite the absence of hyponatremia, CPM was diagnosed based on clinical presentation and MRI findings.
• Following alcohol withdrawal and intensive motor rehabilitation, the patient experienced near-complete resolution of neurological deficits.
• Follow-up MRI after 18 months showed substantial reduction in the pontine lesion size, even with recurrent alcohol consumption.

Implications:

• This case highlights that CPM can occur in alcohol abuse without hyponatremia.
• It demonstrates the potential for significant neurological recovery and lesion reduction in CPM with appropriate management.
• The findings suggest that early intervention and rehabilitation are crucial for improving outcomes in alcohol-related brain injury.