Rapid development of central pontine myelinolysis after recovery from Wernicke encephalopathy: a non-alcoholic case without hyponatremia.

Yuui Kishimoto, Ken Ikeda, Kiyoko Murata, Kiyokazu Kawabe, Takehisa Hirayama, Yasuo Iwasaki

Department of Gastroenterology, Toho University Omori Medical Center, Japan.

Internal medicine (Tokyo, Japan) 2012

filter terms:

We describe a non-alcoholic diabetic patient with central pontine myelinolysis (CPM) and Wernicke encephalopathy (WE). A 69-year-old man developed consciousness disturbance after parenteral hyperalimentation for liver abscess and sepsis. Neurological examination revealed drowsiness and no articulation. MRI disclosed T2-hyperintense lesions in the dorsal medulla oblongata and dentate nuclei, and symmetric enhancement in the inferior colliculus. Thiamine treatment (1,000 mg/day, div) attenuated neurological deficits. Seven days later, WE-related lesions were markedly regressed and a central pontine T2-hyperintensity lesion appeared. Serum sodium levels were normal. Physicians should pay more attention to rapid development of normonatremic CPM under thiamine supplementation in non-alcoholic WE patients.

Citation

Yuui Kishimoto, Ken Ikeda, Kiyoko Murata, Kiyokazu Kawabe, Takehisa Hirayama, Yasuo Iwasaki. Rapid development of central pontine myelinolysis after recovery from Wernicke encephalopathy: a non-alcoholic case without hyponatremia. Internal medicine (Tokyo, Japan). 2012;51(12):1599-603