[Central pontine myelinolysis]

One week after relapsing a 44-year-old female alcoholic and drug addict developed a psycho-organic syndrome. Later she had swallowing and speech dysfunctions and became quadriplegic, the result of central pontine myelinolysis. The signs became most marked in the 5th week of illness and then gradually improved, but an independent existence became impossible. There were no electrolyte disorders. Computed tomography demonstrated the typical lesion (a hypodense focus in the pons, 1 cm in diameter) after the 3rd week, findings confirmed by magnetic resonance imaging. The acoustic evoked potentials were unremarkable. An abnormal eye-closure reflex suggested medulla oblongata damage. The diagnosis of central pontine myelinolysis is difficult because the typical brainstem lesions become demonstrable by various imaging techniques only after some delay.