Central pontine and extrapontine myelinolysis presenting as subacute atypical parkinsonism in a patient with chronic alcoholism

Abstract Central pontine and extrapontine myelinolysis are well known osmotic demyelination syndromes (ODS) that are typically associated with the rapid correction of hyponatremia, chronic alcoholism, and malnutrition. These conditions are often reported to show various brain stem signs and movement disorders. We present the case of 48-year-old man who developed extrapyramidal symptoms owing to central pontine and extrapontine myelinolysis. Magnetic resonance imaging scans showed demyelination in the central pons, bilateral basal ganglia, and thalamus. After dopamine replacement therapy, the patient’s symptoms improved significantly.