Abstract

Central pontine myelinolysis (CPM) is a rare disorder characterized by non-inflammatory demyelination in the central pons. It was first reported in necropsy cases of alcoholism and malnutrition. It is a condition most frequently related to rapid correction of hyponatremia. CPM is characterized by disturbance of consciousness, quadriparesis and mutism. It has been considered to have a poor prognosis. 100 cases of CPM associated with electrolyte disturbance have been reported worldwide since 1959. Hypokalemia associated CPM has also been reported. We hereby present a 60-year-old male, who had come with complaints of fever, vomiting and headache for five days. Vitals were normal. Patient was found to be drowsy, having slurred speech with deteriorating sensorium and flaccid quadriparesis. Serum electrolytes revealed hyponatremia, hypokalemia and hypochloridemia. Other blood parameters were normal. Sodium and potassium corrections were done as per recommended guidelines within normal limits. There was improvement in sensorium but the quadriparesis persisted. MRI imaging of brain was done which showed signal intensity of the pons on axial T2 weighted images. A final diagnosis of Central Pontine Myelinolysis was made. Central pontine myelinolysis is a rare complication of long standing hypokalemia. Electrolyte abnormality other than sodium should be investigated and rectified.