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Open Access Highly Accessed Case report

Extrapontine myelinolysis presenting as acute parkinsonism

J Sajith1, A Ditchfield2 and HA Katifi3*

Author Affiliations

1 Department of Adult Medicine, Queen Elizabeth Hospital, Woolwich, London. Correspondence to: 82 St Nicholas House, Queen Elizabeth Hospital, Stadium Road, Woolwich, London, SE 18 4QN, UK

2 Department of Neuroradiology, Southampton General Hospital, Southampton SO9 4XY, UK

3 Department of Neurology, Southampton General Hospital, Southampton SO9 4XY, UK

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BMC Neurology 2006, 6:33  doi:10.1186/1471-2377-6-33

Published: 10 September 2006

Abstract

Background

Extrapontine myelinolysis presenting with extra pyramidal features suggestive of parkinsonism may be a challenging clinical syndrome. Clinicians should maintain their vigilance while correcting electrolyte imbalances, especially with associated co-morbidity.

Case presentation

A 41-year-old woman presented with acute parkinsonism like features while on a holiday. This followed slow correction of hyponatraemia after repeated vomiting. MRI changes were suggestive of Extrapontine myelinolysis(EPM). This case is at variance with four previous cases reported in the medical literature in that the patient made a full clinical recovery and the MR changes resolved with symptomatic support alone.

Conclusion

Extrapontine myelinolysis could make a complete recovery with symptomatic support alone. During hyponatraemia correction, rapid osmotic shifts of fluid that cause hypernatremia, causes myelinolysis rather than absolute serum sodium level.

Even gradual correction of hyponatraemia can produce myelinolysis, especially with pre-existing malnourishment, alcoholism, drug misuse, Addison's disease and immuno-suppression. Pallidial sparing is typical of EPM in MRI scans.