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논문분류	춘계학술대회 초록집
제목	A Case of spontaneous full recovery from Central Pontine Myelinolysis
저자	Hong Jae Jeon*, Won Jung Choi, Hae Ri Kim, Young Rok Ham, Dae Eun Choi, Ki-Ryang Na, Kang Wook Lee
출판정보	2016; 2016(1):
키워드	None
초록	Background: Central pontine myelinolysis(CPM) is a neurological disease characterized by destruction of myelin sheaths of brain cells in the pons, usually caused by rapid correction of chronic hyponatremia. CPM presents clinically dysarthria, dysphagia, and flaccid quadriparesis. Although previous reports on CPM described very poor outcome. Recent some reported that relowering of serum sodium within 24hr after symptom onset showed a favorable recovery from CPM. However, it is not usual spontaneous full recovery from CPM without relowing of Na. We report a case of 59-year-old woman diagnosed with CPM, associated with hyponatremia correction, and recovered spontaneously. Methods: Medical record review Results: A 59-year-old woman who had type 2 diabetes mellitus, hypertension and chronic alcoholism presented to our hospital with scalp laceration. She was found collapsed in her room by son. On admission she was alcohol ordor state, but she was alert. She complained nausea and vomiting which had evolved 2 days. On physical examination upon admission, the patient's blood pressure was 154/81 mmHg, Serum biochemistry showed sodium of 111.1 mEq/L, Serum osmolality was 239 mOsmo/kg and glucose was 122 mg/dL Urine sodium was less than 10 mEq/L. Brain CT and DWI was performed, but revealed no abnormality. She was treated with intravenous 3% sodium chloride with potassium supplementation. And six hours later, when serum sodium was 119.9 mEq/L, 3% saline was stopped and we started 0.9% sodium chloride. At that night, she showed severe emotional lability and disorientation. She didn’t sleep all night. On 2nd admission day, serum sodium was 130.4 mEq/L. We consult to psychiatry about anxiety. She was diagnosed with delirium tremens and started on chlordiazepoxide, parenteral thiamine. On 3rd admission day, serum sodium reaches 137.8 mEq/L. On 5th admission day, patient became drowsy. Neurological examination revealed general weakness, but no limb ataxia and opthalmoplegia. Focal neurologic deficits were not observed. So we suspected drug side effect due to chlordiazepoxide. We decided to reduce chlordiazepoxide. On 9th admission day, her drowsy mental state didn’t improved. We stopped chlordiazepoxide. Brain MRI was performed, and MRI showed high signal intensity in the central pons and bilateral basal gangli and thalamus on T2-weighted image and diffusion weighted imaging. She was diagnosed with CPM and EPM. We continued supportive care since then, but she couldn’t speak and couldn’t move her extremities herself for a long time. While continuing supportive care, her drowsy mental state gradually improved. On 22th admission day, she became alert and could handshake. On 26th admission day, she was discharged to convalescent hospital. Three weeks after discharge, when she came to opd, she showed full recovered neurologic problem. Conclusion: . Table: .
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