A 4-year-old boy was seen in an emergency department after 3 days of vomiting and watery diarrhea. After his sodium level decreased from 136 to 118 mEq/L, he had a seizure, resulting in respiratory arrest, and required mechanical ventilation. His sodium level increased to 128 mEq/L with rehydration, but he developed “locked-in syndrome.”
His initial magnetic resonance image revealed increased signal lesions in the left pons, right basal ganglia region, and both medial temporal lobes (Figure).
Choksi R, Roach ES. Ring-Enhancing Lesion in Central Pontine Myelinolysis. Arch Neurol. 2005;62(6):1016-1017. doi:10.1001/archneur.62.6.1016