Objective: To report a patient with acute onset parkinsonism due to extrapontine myelinosis.

Background: Osmotic demyelinating diseases of the central nervous system appear to be two distinct variants namely central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM). Parkinsonism has been rarely described complicating these entities.

Method: A 61-year-old female was admitted to the emergency department with complaints of generalised weakness, nausea, vomiting and shuffling gait for two days. Blood analyses revealed severe hyponatremia with serum sodium of 104 mEq/L (132 – 146 mEq/L) and serum potassium level was 2.74 mEq/L (3.5 – 5.5 mEq/L). After rehydration, her complaints did not regress and her speech worsened. With a deteriorating condition and no clear diagnosis she was taken to the neurology intensive care unit. On neurological examination she was lethargic and she had no verbal output.

Results: A week after the discharge she was admitted to our neurology intensive care unit because of worsening general condition, decreased oral intake and progress of parkinsonism symptoms. Her sodium level was normal (139 mEq/L). The MRI showed demyelinations in the central part of the pons and peripheral parts of the  basal ganglia and thalamus. Lesions were brightening in diffusion-weighted series, and showing hyperintensity in the simultaneous fluid attenuated inversion recovery (FLAIR) sequence  (Figure 1)

Conclusion: We report a case of osmotic demyelination syndrome presenting as acute parkinsonism. CPM and EPM have a wide range of clinical presentations, and the onset symptoms may be delayed. Correction of serum sodium should not exceed 8mEq/L per day to prevent occurrence of ODS

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pontine-and-extrapontine-myelinolysis-presenting-as-acute-parkinsonism/