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September 1988

Pathologic Crying as a Prominent Behavioral Manifestation of Central Pontine Myelinolysis

Author Affiliations

Department of Neurology
Department of Neuroradiology
Department of Internal Medicine University Hospital, Leiden Rijnsburerweg 10 2333 AA Leiden, the Netherlands

Arch Neurol. 1988;45(9):936. doi:10.1001/archneur.1988.00520330010001

To the Editor.  —Recently, Price and Mesulam1 drew attention to the behavioral manifestations of central pontine myelinolysis (CPM). In addition, we report a case of pathologic crying that developed several days after the rapid correction of hyponatremia.

Report of a Case.  —A 45-year-old man was admitted to the hospital because of Wernicke's encephalopathy, malnutrition, and dehydration. Laboratory data showed a serum sodium level of 116 mmol/L and a moderate uremia due to inadequate salt and water intake and chronic vomiting. During the first 24 hours, 3 L of 0.9% saline solution was infused. Treatment with 300 mg of thiamine hydrochloride, administered intramuscularly daily, was started. The serum sodium level gradually increased to a value of 132 mmol/L. However, during the following days, he developed emotional lability and difficulty in swallowing. Examination revealed that the patient was slow of thought, inattentive, and frequently cried spasmodically. Smooth pursuit of eye movements

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