Central Pontine Myelinolysis in Patient with Normal Serum Sodium Levels, System Alcohol Use and Malnutrition- A Case Report

Central pontine myelinolysis (CPM) is heterogeneous group of demyelinating conditions with different etiology, pathophysiological mechanisms, clinical presentation and development. The suspectable main reasons for development of pontine myelinolysis syndrome in patients with alcohol use and malnutrition are basically deficiency of thiamine - vitamin B1 and direct toxic effects of acetaldehyde. Role in cell damage plays changes in serum potassium levels and accompanying these conditions magnesium deficiency. Early and proper diagnosis of pontine myelinolysis syndrome should be based on acute brain stem dysfunction, history and clinical data of serum electrolyte disturbances, alcohol consumption and malnutrition, as well as typical findings of magnetic resonance imaging (MRI). We present a case of 42 years old female patient with history of long-term alcohol abuse, normal serum sodium levels and malnutrition after ten-day period of confusion and aggressive behavior develops acute bulbar, pseudo bulbar and quadriparetic syndrome, which requires hospitalization in intensive care unit. Several MRI studies were performed and patient was diagnosed with central pontine myelinolysis syndrome as a result of malnutrition and alcohol abuse. In six months complete reversal of neurological symptoms was observed, but MRI findings persist. Basic etiological reasons were discussed, as well as possible pathophysiological mechanisms, clinical and diagnostic possibilities for patient with CPM syndrome, systemic alcohol abuse, malnutrition and normal serum sodium levels.