Expanding the clinical spectrum of central pontine myelinolysis

Central Pontine Myelinolysis (CPM) is a clinical entity first described by Adams et all in 1958 in the context of malnourishment and alcoholism. Classically, this demyelinating disease arises from the rapid correction of hyponatraemia, resulting in profound neurological deficits such as spastic quadraplegia and pseudobulbar palsy. Diagnosis is usually made on the presence of a symmetrical, centralized and well-circumscribed lesion in the pens, seen on MRI. Extrapontine lesions have also been described, frequently affecting the midbrain, thalamus, cerebellum and rarely extends to the medulla. We present a case of a 41 year old lady who presented with acute neurological deterioration, with physical signs to suggest a disease process involving the whole brainstem. However, MRI brain showed a lesion similar to that found in CPM, at the junction of the pons and medulla.