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Images in Neurology
February 2016

Striking Central Pontine Myelinolysis in a Patient With Alcohol Dependence Syndrome Without Hyponatremia

Author Affiliations
  • 1Department of Neurology, Movement Disorders Unit, and Stroke Service, The Adelaide and Meath Hospital and Trinity College, Dublin, incorporating the National Children’s Hospital, Dublin, Ireland
  • 2Academic Unit of Neurology, School of Medicine, Trinity College, Dublin, Ireland
  • 3Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, England
JAMA Neurol. 2016;73(2):234-235. doi:10.1001/jamaneurol.2015.2201

A man in his 70s with known alcohol dependence syndrome was admitted to our institution after he was found collapsed at home. He reportedly consumed more than 1 bottle of liquor daily for several years. On general examination, he was unkempt and had a low body mass index consistent with his poor nutritional status. Neurological examination revealed gaze-evoked nystagmus in all directions, severe dysarthria, limb and truncal ataxia, and extensor plantars.

Neuroimaging revealed a striking triangular central pontine defect in keeping with central pontine myelinolysis (CPM) (Figure). The patient had normal sodium and glucose levels throughout his admission and for the previous 12-month period. Treatment with high-dose intravenous thiamine only led to a partial clinical improvement. He remained significantly disabled, unable to weight-bear, and required assistance with all activities of daily living by the time of his discharge.

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