A Case of Central Pontine Myelinolysis Unrelated Serum Sodium Level in Traumatic Brain Injury Patient

Central pontine myelinolysis (CPM) is a disorder wherein variable symptoms are associated with pontine dysfunction. It has been known to occur inconstantly, particularly when serum sodium in patients with prolonged hyponatremia is rapidly corrected. Further, it is known that patients with liver diseases, malnutrition, malignancy, adrenal insufficiency, and metabolic derangements are more vulnerable to this disorder. However, there is limited literature about the occurrence of CPM in patients with traumatic brain injury, especially in those with normal serum sodium levels. A 36-year-old man having no medical history was bought to our hospital due to an open skull fracture and underwent surgery. During the hospitalization period, he showed a sudden pseudobulbar palsy and rigidity. Imaging study of the brain was characteristic for CPM. He had no fluctuation of serum sodium levels during the hospitalization period. We speculate that the brain trauma itself might cause a CPM, and its pathophysiology may not be related to rapid serum sodium correction.