Acute Psychosis as Main Manifestation of Central Pontine Myelinolysis

Gopal, Mangala; Parasram, Melvin; Patel, Harsh; Ilorah, Chike; Nersesyan, Hrachya

doi:10.1155/2017/1471096

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…Central pontine myelinolysis is an acute demyelinating neurological disorder affecting the central pons primarily and is frequently associated with rapid correction of hyponatremia. There is some evidence that central pontine myelinolysis may occasionally present with neuropsychiatric manifestations, including catatonia [23,24] In cases of multi-morbidity, it may not be clear whether hyponatremia is the single cause of catatonic syndrome. Presumably, multiple causal factors may act synergistically to cause catatonia.…”

Section: Discussionmentioning

confidence: 99%

Catatonia Associated with Hyponatremia: Case Report and Brief Review of the Literature

Peritogiannis¹,

Rizos

2021

CPEMH

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Background: Catatonia is a syndrome of altered motor behavior that is mostly associated with general medical, neurologic, mood and schizophrenia-spectrum disorders. The association of newly onset catatonic symptoms with hyponatremia has been rarely reported in the literature. Case Presentation: We present a rare case of a young female patient with schizophrenia, who presented with catatonic symptoms in the context of hyponatremia due to water intoxication. The symptoms were eliminated with the correction of hyponatremia. There are only a few reports of hyponatremia-associated catatonia in psychiatric and non-psychiatric patients. Sometimes, catatonic symptoms may co-occur with newly onset psychotic symptoms and confusion, suggesting delirium. In several cases, the catatonic symptoms responded to specific treatment with benzodiazepines or electroconvulsive therapy. Conclusion: Hyponatremia may induce catatonic symptoms in patients, regardless of underlying mental illness, but this phenomenon is even more relevant in patients with a psychotic or mood disorder, which may itself cause catatonic symptoms. It is important for clinicians not to attribute newly-onset catatonic symptoms to the underlying psychotic or mood disorder without measuring sodium serum levels. The measurement of sodium serum levels may guide treating psychiatrists to refer the patient for further investigation and appropriate treatment.

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Section: Discussionmentioning

confidence: 99%

Catatonia Associated with Hyponatremia: Case Report and Brief Review of the Literature

Peritogiannis¹,

Rizos

2021

CPEMH

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“…However, ODS uncommonly can occur with behavioral and neuropsychiatric symptoms. There is rare available literature describing behavioral manifestations (personality changes, labile affect, disinhibition, poor judgment, paranoid delusions, emotional lability, delirium, hallucinations, and catatonia), particularly in lesions that saves central line regions 5 .…”

Section: Introductionmentioning

confidence: 99%

Pontine myelinolysis with an uncommon manifestation of hallucination: a case report

Azzoni,

Arca,

Melo

2024

Dement. neuropsychol.

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This report aims to present an elderly woman with persistent delirium after hospitalization for lethargy secondary to hyponatremia. The diagnosis of pontine myelinolysis was made and there were no characteristic neurological manifestations such as pupillary changes or spastic tetraparesis. Hallucinations and personality changes were the clues to the diagnosis and should be considered an atypical manifestation of pontine myelinolysis.

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“…False perceptions (hallucinations) and false beliefs (delusions) are mental phenomena representing the core of the symptomatology of schizophrenia. However, such symptoms are also frequently observed in persons with brain damage ( 1 – 3 ), but only rarely detected in patients with severe acquired brain injury, including those with locked-in syndrome (LIS) ( 4 , 5 ). LIS is the result of a complete interruption of corticospinal, corticobulbar, and corticocerebellar pathways as a consequence of specific pontine damage usually resulting from a stenosis of the basilar artery.…”

Section: Introductionmentioning

confidence: 99%

Cortical Brain Changes in Patients With Locked-In Syndrome Experiencing Hallucinations and Delusions

Sarà¹,

Cornia

Conson

et al. 2018

Front. Neurol.

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Previous evidence suggests that hallucinations and delusions may be detected in patients with the most severe forms of motor disability including locked-in syndrome (LIS). However, such phenomena are rarely described in LIS and their presence may be underestimated as a result of the severe communication impairment experienced by the patients. In this study, we retrospectively reviewed the clinical history and the neuroimaging data of a cohort of patients with LIS in order to recognize the presence of hallucinations and delusions and to correlate it with the pontine damage and the presence of any cortical volumetric changes. Ten patients with LIS were included (5 men and 5 women, mean age 50.1 ± 14.6). According to the presence of indicators of symptoms, these patients were categorized as hallucinators (n = 5) or non-hallucinators (n = 5). MRI images of patients were analyzed using Freesurfer 6.0 software to evaluate volume differences between the two groups. Hallucinators showed a selective cortical volume loss involving the fusiform (p = 0.001) and the parahippocampal (p = 0.0008) gyrus and the orbital part of the inferior frontal gyrus (p = 0.001) in the right hemisphere together with the lingual (p = 0.01) and the fusiform gyrus (p = 0.01) in the left hemisphere. Moreover, a volumetric decrease of bilateral anterior portions of the precuneus was recognized in the hallucinators (right p = 0.01; left p = 0.001) as compared to non-hallucinators. We suggested that the presence of hallucinations and delusions in some LIS patients could be accounted for by the combination of a damage of the corticopontocerebellar pathways with cortical changes following the primary brainstem injury. The above areas are embedded within cortico-cortical and cortico-subcortical loops involved in self-monitoring and have been related to the presence of hallucinations in other diseases. The two main limitations of our study are the small sample of included patients and the lack of a control group of healthy individuals. Further studies would be of help to expand this field of research in order to integrate existing theories about the mechanisms underlying the generation of hallucinations and delusions in neurological patients.

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Acute Psychosis as Main Manifestation of Central Pontine Myelinolysis

Cited by 5 publications

References 28 publications

Catatonia Associated with Hyponatremia: Case Report and Brief Review of the Literature

Catatonia Associated with Hyponatremia: Case Report and Brief Review of the Literature

Pontine myelinolysis with an uncommon manifestation of hallucination: a case report

Cortical Brain Changes in Patients With Locked-In Syndrome Experiencing Hallucinations and Delusions

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