Medical Case Reports

Central Pontine Myelinolysis, Osmotic Demyelination Syndrome Due to Rapidly Decreased Fluid Intake in a Schizophrenic Patient with Psychogenic Polydipsia: A Case report and Review of The Literature

Central pontine myelinolysis is a rare entity of osmotic demyelinating disease that mostly affects the basis pontis in brainstem. The clinical picture of central pontine myelinolysis can be variable and mixed, manifestations such as pseudobulbar palsy, various degrees of spastic paraparesis and tetraparesis, ataxia and diminished deep tendon reflexes can all occur. Etiology of central pontine myelinolysis has been reported to be mostly attributed by rapid changes in serum osmolality. Magnetic Resonance Imaging is the only way to confirm the diagnosis of central pontine myelinolysis. In this report, we describe an unusual case of central pontine myelinolysis in a 39 years old male patient who had a long-standing history of psychogenic polydipsia, compulsive water intake associated with schizophrenia that was referred to our hospital for deteriorating level of consciousness and generalized weakness after a sudden decrease in his oral water intake and sudden withdrawal of lithium treatment. We review this uncommon etiology of central pontine myelinolysis in the patient as well as pathophysiological mechanisms involved.

Author(s):

Hamza M Alsaid and Anis M Naser

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