Central pontine myelinolysis with extrapontine lesions

An autopsy case of central pontine myelinolysis (CPM) was reported. The patient, a 48-year-old man, with a long history of alcoholic intake appeared in a hospital with the diagnosis of alcoholic hepatitis and the neurologic symptoms of delirium tremens. During the hospital course he fell into "locked in" with concomitant development of marked hyponatremia (92 mEq/1). An autopsy revealed typical CPM and the extra-pontine myelinolytic lesions distributed symmetrically in the thalami, subthalamic nuclei, and lateral geniculate bodies. Spongiosis was also found in the deep layer of the cerebral cortex and in the putamen. It was suggested that CPM occur in close association with marked hyponatremia and the extrapontine involvement be likely to manifest in the deep layer of the cerebral cortex, putamen, thalamus, and lateral geniculate body, where the myelin cylinders form an interlacing network embedding large neurons and oligodendrocytes.