[Central pontine and extra-pontine myelinolysis following rapid correction of hyponatremia--a case report]

Abstract

An autopsy case of central pontine and extrapontine myelinolysis following rapid correction of hyponatremia is reported. Hyponatremia was induced by massive devastation of adrenal cortex due to tuberculosis. Severe hyponatremia (approximately 100 mEq/l of serum sodium level) was rapidly corrected by infusion of hypertonic saline solution within two days. After transient regression of her consciousness, the patient developed decorticated state and then complete paralysis of all limbs. She died of pneumonia approximately one month after the last illness. The autopsy revealed myelynolysis in the center of the pontine basis. The nerve cells and axon cylinders were relatively well preserved. In addition, the similar lesions were seen in the subcortical gray matter and cerebral cortex. The thin white matter at the site characterized by an extensive admixture of gray and white matter was selectively involved. The pathogenesis of this disorder is briefly discussed.