Is Fatty Liver the Last Nail in The Coffin for Central Pontine Myelinolysis? A Case Report and Literature Review

We report a case of a 45-year-old male admitted with recurrent falls, melaena, abdominal pain, vomiting, deranged electrolytes, and a low heamoglobin. He has a complex past medical history, including a lung abscess, alcohol abuse, a history of falls, cholecystitis, duodenal ulcer, duodenitis, epilepsy, folate deficiency, an ankle fracture, gallstones, a history of anoxic brain injury, and pancreatitis. His medications include lamotrigine, losartan, quetiapine, omeprazole, and venlafaxine MR. The patient's history reveals excessive alcohol intake, malnutrition, and smoking. Ultrasound showed the presence of diffuse fatty liver and gallstones. He developed left-sided weakness, which was not present before. MRI of the head revealed a classic trident appearance in the pons, consistent with post-motor demyelination/pontine myelinolysis. It was noted that a few days prior to the MRI, the patient had been treated for mild hyponatraemia, and 10 days before, he had been noted to have mild hypernatremia. In this case report, we demonstrate how fatty liver can be associated with an increased risk of central pontine myelinolysis (CPM).