A Case of Extrapontine Myelinolysis Presented by Psychiatric Symptoms
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Osmotic demyelination syndrome (ODS), especially extrapontine myelinolysis (EPM), is a rare neurological disorder caused by damage to the myelin sheath of the brain. We encountered a 24-year-old man with psychiatric symptoms who was diagnosed with EPM following rapid correction of hyponatremia. Hyponatremia was induced by primary polydipsia; the serum sodium concentration of the patient was 97 mEq/L. Previous medical history included mental retardation and epilepsy after childhood. His seizures had been well controlled with antiepileptic drugs for about 10 years. After admission, he was administered intravenous 3% NaCl, which increased his serum sodium concentration to 135 mEq/L over 6 days. After discharge, he complained of general weakness, agitation and insomnia and was readmitted. Brain magnetic resonance imaging showed symmetric T2 signal changes in the bilateral caudate head, putamen, and sparing globus. He was diagnosed with EPM and treated with diazepam and quetiapine, an atypical antipsychotic drug. Eight days later, his symptoms had improved. This study describes a 24-year-old man with psychiatric symptoms who was diagnosed with EPM caused by rapid correction of hyponatremia.
Abstract
Osmotic demyelination syndrome (ODS), especially extrapontine myelinolysis (EPM), is a rare neurological disorder caused by damage to the myelin sheath of the brain. We encountered a 24-year-old man with psychiatric symptoms who was diagnosed with EPM following rapid correction of hyponatremia. Hyponatremia was induced by primary polydipsia; the serum sodium concentration of the patient was 97 mEq/L. Previous medical history included mental retardation and epilepsy after childhood. His seizures had been well controlled with antiepileptic drugs for about 10 years. After admission, he was administered intravenous 3% NaCl, which increased his serum sodium concentration to 135 mEq/L over 6 days. After discharge, he complained of general weakness, agitation and insomnia and was readmitted. Brain magnetic resonance imaging showed symmetric T2 signal changes in the bilateral caudate head, putamen, and sparing globus. He was diagnosed with EPM and treated with diazepam and quetiapine, an atypical antipsychotic drug. Eight days later, his symptoms had improved. This study describes a 24-year-old man with psychiatric symptoms who was diagnosed with EPM caused by rapid correction of hyponatremia.
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