
==== Front
Intern Med
Intern Med
Internal Medicine
0918-2918
1349-7235
The Japanese Society of Internal Medicine

38171872
10.2169/internalmedicine.2932-23
Pictures in Clinical Medicine
Central Pontine and Extrapontine Myelinolysis with Severe Hypernatremia
Kondo Hikari 1
Suami Kazuya 2
Nakashima Natsumi 2
Mabuchi Naoki 1
1 Department of Neurology, Nagoya Ekisaikai Hospital, Japan
2 Department of Emergency, Nagoya Ekisaikai Hospital, Japan
Correspondence to Dr.　Hikari Kondo, kondohikari1923fp@gmail.com

2 1 2024
15 8 2024
63 16 23392340
18 9 2023
5 11 2023
Copyright © 2024 by The Japanese Society of Internal Medicine
https://creativecommons.org/licenses/by-nc-nd/4.0/ The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).
central pontine myelinolysis
extrapontine myelinolysis
hypernatremia
magnetic resonance imaging
==== Body
pmcA 49-year-old woman with bipolar disorder presented with dysphagia caused by drug-induced parkinsonism. She was initially hospitalized and received parenteral nutrition for two weeks, and her level of consciousness gradually deteriorated. A laboratory analysis revealed severe hypernatremia, and the patient was transferred to our hospital. Her sodium level was 185 mEq/L, and she was administered 5% dextrose in water (D5W), which led to gradual normalization of the sodium level (Picture 1) and mild improvement in consciousness. However, memory impairment and paresis were also observed. Brain magnetic resonance imaging was performed two weeks after post-D5W administration, and fluid-attenuated inversion recovery and diffusion-weighted imaging revealed well-defined bilateral hyperintense lesions in the hippocampus and basis pontis, sparing the corticospinal tract (arrows), which exhibited a low signal intensity on T1-weighted imaging (Picture 2). She was diagnosed with central pontine myelinolysis and extrapontine myelinolysis. Although hypernatremia as in this case is rare, it should be noted that severe hypernatremia can cause brain myelinolysis (1).

Picture 1.

Picture 2.

The authors state that they have no Conflict of Interest (COI).
==== Refs
1. Levin J , Högen T , Patzig M , Pfister HW , Peters N . Pontine and extrapontine myolinolysis associated with hypernatraemia. Clin Neurol Neurosurg 114 : 1290-1291, 2012.22502786
