Central Pontine Myelinolysis in a Patient with Alcohol Use Disorder without Hyponatremia: A Case Report

BACKGROUND Central pontine myelinolysis (CPM) is an osmotic demyelination syndrome most commonly observed in patients with chronic hyponatremia who undergo rapid serum sodium correction. Risk factors for CPM include malnutrition, hypokalemia, advanced liver disease, hyperemesis gravidarum, and alcohol use disorder. In this case report, we present an unusual case of CPM in a 30-year-old man with alcohol use disorder who did not have hyponatremia during hospitalization and had no history of chronic hyponatremia. CASE REPORT A 30-year-old man was admitted to the hospital for alcohol detoxification. He presented with symptoms of alcohol withdrawal and distal lower-limb pain, accompanied by bilateral edema. After his withdrawal symptoms were controlled, persistent neurological abnormalities prompted an MRI, which revealed lesions suggestive of central pontine myelinolysis (CPM). The patient did not exhibit hyponatremia during his hospital stay. However, he had multiple previously identified risk factors for CPM, including significant alcohol consumption leading to malnutrition and refeeding syndrome-associated hypokalemia. The neurological exam performed 1 month after the onset of symptoms showed a favorable outcome without signs of dystonia or cerebellar syndrome, but with persistent left-wrist extrapyramidal rigidity. CONCLUSIONS This case report highlights the importance of a thorough neurological examination in patients with alcohol use disorder, to prevent falsely attributing neurological symptoms to alcohol intoxication. Clinicians should remain vigilant about the risk of CPM in patients with alcohol use disorder, even in the absence of hyponatremia, considering that other metabolic disturbances can contribute to its pathogenesis.