Objective: To describe a patient with osmotic myelinolysis caused by change in blood alcohol level who developed acute parkinsonism.

Background: Osmotic myelinolysis is an acute, rare, demyelinating process. It is mainly caused by the rapid correction of hyponatremia. However, there are case reports of osmotic myelinolysis without associated hyponatremia. Although the exact pathogenesis is still unclear, it is suggested that it occurs not only due to sodium ion abnormality but also when the extracellular fluid is relatively hypertonic compared to intracellular fluid.

Method: Case report

Results: A 71 years old man was admitted to our hospital with consciousness disturbance. The patient had a history of chronic alcoholism. Although the cause of disturbance of consciousness at the time of admission was unclear, it improved naturally. However, parkinsonism (bradykinesia and gait disturbance) emerged from the 15th hospital day, and it progressed rapidly. About one week later he became nearly bedridden. The brain MRI showed high signal on bilateral globus pallidus in T2WI and FLAIR images. This finding was not observed in the brain MRI at the time of admission. Considering this finding together with medical history and neurological examination, osmotic demyelination may have occurred. He received general management and was treated with levodopa. He improved gradually over time. After about a month, he got to understand our instruction a little and began to move his limbs slightly. The laboratory tests on admission revealed elevation of blood ethanol level (144mg/dl). Serum sodium was 131 mEq/l. The next day, serum sodium was 138mEq/l. Considering the osmotic pressure change accompanying the lowering of the blood ethanol level, there is an osmotic pressure change of about 18 mOsm/kg in one day. It was equivalent to 9mEq/l converted to change in sodium concentration. We considered that this change in osmotic pressure caused osmotic myelinolysis.

Conclusion: Change of ethanol concentration also affects blood osmotic pressure besides sodium, blood glucose and BUN. When we treat a patient with a history of acute and chronic alcohol addiction, it is necessary to carefully manage blood osmotic pressure considering alcohol metabolism.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-case-of-osmotic-demyelination-syndrome-presenting-parkinsonism-affected-by-blood-alcohol-concentration-change/