Parkinsonism after correction of hyponatremia with radiological central pontine myelinolysis and changes in the basal ganglia

• Published in: Journal of clinical neuroscience Vol. 7; no. 3; pp. 256 - 259
• Main Authors: Sullivan, A.A, Chervin, R.D, Albin, R.L
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01.05.2000; Elsevier
• Subjects: Antiparkinson Agents - therapeutic use; Basal Ganglia - pathology; Biological and medical sciences; Fluid Therapy - adverse effects; Humans; Hyponatremia - complications; Hyponatremia - therapy; Magnetic Resonance Imaging; Male; Medical sciences; Metabolic diseases; Middle Aged; Myelinolysis, Central Pontine - etiology; Myelinolysis, Central Pontine - pathology; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...); Parkinsonian Disorders - drug therapy; Parkinsonian Disorders - etiology; Parkinsonian Disorders - pathology; parkinsonism, hyponatremia, central pontine myelinolysis, extrapontine myelinolysis; parkinsonism, hyponatremia, central pontine myelinolysis, extrapontine myelinolysis; Human; Nervous system diseases; Hydroelectrolytic balance disorder; Hyponatremia; Basal ganglion; Inorganic element; Nuclear magnetic resonance imaging; Cerebral disorder; Case study; Parkinsonism; Metabolic disorder; Demyelination; Central nervous system disease; Pons varolii; Medical imagery; Complication; Corrections
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1054/jocn.1999.0192

Parkinsonism has been rarely described following central pontine and extrapontine myelinolysis. We report a case of parkinsonism developing following rapid correction of hyponatremia with radiological evidence of central pontine myelinolysis and changes in the basal ganglia. A 56-year-old man developed drooling and bilateral hand tremors 3 weeks after correction of hyponatremia from 103 to 125 mmol/L over 14 h. He had a prominent 6 Hz resting tremor which worsened with action and mild cogwheel rigidity. Magnetic resonance imaging (MRI) showed changes consistent with central pontine myelinolysis and increased signal on T1-weighted images in the putamen bilaterally. His tremor responded well to L-dopa therapy. There have been several other cases of parkinsonism developing after central pontine/extrapontine myelinolysis. Increased signal in the basal ganglia on T1-weighted images has been described in another case of central pontine myelinolysis imaged about the same time after sodium correction as our case.