Pontine and Extrapontine Myelinolysis Following Rapid Correction of Severe Hyponatremia: Case Report.

Introduction Central Pontine Myelinolysis is a rare neurological disorder caused by myelin loss in the central pons, often linked to rapid correction of chronic hyponatremia [1]. Symptoms range from mild encephalopathy to coma. Diagnosis relies on MRI and clinical signs, with prevention focusing on gradual sodium correction [2]. This case underscores the risks of rapid electrolyte shifts. Case Presentation This case report presents a 49-year-old male who developed pontine and extrapontine myelinolysis following rapid correction of severe hyponatremia. He was admitted to the Emergency Department at Kaunas Clinics from district hospital where he was treated for an unspecified infection for 11 days. During his hospitalisation severe hyponatremia of 98,6 mmol/L was identified, which improved to 140 mmol/L in 10 days. He presented with symptoms including altered consciousness, bulbar symptoms, and limb weakness. A head computed tomography scan was performed, which ruled out cerebrovascular accidents and other structural changes. For further evaluation, the patient was admitted to the Neurology Department, where it was decided to perform a brain magnetic resonance imaging scan, which suggested possible extrapontine and pontine myelinolysis. The patient was treated in the Neurointensive Care Unit for 5 days due to coma and respiratory failure. Based on a review of the scientific literature, treatment with methylprednisolone was initiated as there was no specific treatment available. Given the clinical progression and observed changes, the prognosis was deemed unfavorable and patient passed away on a fifth day. Discussion This case highlights that rapid sodium correction can lead to serious complications. Overcorrection of hyponatremia is defined as a serum sodium increase of >10 mmol/L in 24 hours, >18 mmol/L in 48 hours, or >8 mmol/L/day after the first 24 hours [3]. Therapeutic approaches for myelinolysis such as steroids, plasmapheresis, and intravenous immunoglobulin offer potential benefits but lack standardized protocols [4]. Further research is needed to enhance understanding and management of pontine and extrapontine myelinolysis, particularly in severe cases. Conclusions Rapid sodium correction can cause severe complications like myelinolysis. Gradual correction and further research are crucial for better management.