Sudden parkinsonism, cognitive decline and behavioral changes - drug-induced or other iatrogenic origin?

Abstract

Central pontine myelinolysis and extrapontine myelinolysis are osmotic demyelination syndromes due to rapid correction of severe hyponatremia. Their clinical manifestations may often vary.

We report a case of a patient with rapid onset of neuropsychiatric symptoms and parkinsonism following rapid correction of hyponatremia, with an initially considered drug-induced etiology. MRI findings compatible with central pontine and extrapontine myelinolysis, however, developed only with a delay of several weeks when clinical symptoms were already disappearing.

Keywords

• central pontine myelinolysis
• extrapontine myelinolysis
• osmotic demyelination syndrome
• parkinsonism