Affective symptoms in an individual with central pontine myelinolysis – A case report

Abstract

Background: Central pontine myelinolysis is a condition characterized by damage to regions of the brain, the most common site being pontine white matter tracts, following a rapid correction of metabolic disturbances such as hyponatremia. Extrapontine sites that may be involved include the caudate and the lentiform nuclei, putamen, thalami, cerebellum, hippocampus, and cerebral cortex. Case report: A female aged 34 years presented with gastritis. Baseline investigations did not suggest an infective picture. Her serum sodium levels were noted as 101 meq/l at admission. Corrective measures were carried out, and serum sodium levels increased to 133 meq/l in 3 days. Within three days, she developed manic symptoms. Psychiatry consultation was sought, and she was admitted to the Psychiatry ward. MRI of the Brain confirmed both central and extrapontine myelinolysis. She was treated with mood stabilizers and antipsychotics and was discharged in two weeks with complete remission of symptoms. Discussion: Neuropsychiatric symptoms developing in the background of rapid correction of serum sodium levels have been reported in a few studies previously. Focus on brain areas involved in such cases may provide insight regarding the possible role of these brain areas in the etiopathogenesis of these symptoms.