An Unusual Case of Extrapontine Myelinolysis in a Post-partum Woman with Hypernatremia

Hypernatremia is a condition that can lead to severe neurological symptoms, including flaccid paralysis, cognitive impairment, encephalopathy, and coma. Osmotic demyelination syndrome (ODS), which encompasses central pontine myelinolysis and extrapontine myelinolysis (EPM), is a known complication of the rapid correction of sodium levels. Limited data exist on the occurrence of ODS in post-partum women, particularly those with hypernatremia. Here, we present a case of a post-partum lady who presented in an unconscious and agitated state with hypernatremia and was found to have imaging characteristics consistent with hypernatremic demyelination. Despite a moderately elevated sodium level, she exhibited typical symptoms and imaging findings of EPM. While previously reported cases often involve patients with significantly higher sodium levels, this case highlights the importance of maintaining a low threshold for suspicion of ODS, particularly in post-partum women with hypernatremia, to prevent catastrophic consequences.