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Images in Neurology |

Striking Central Pontine Myelinolysis in a Patient With Alcohol Dependence Syndrome Without Hyponatremia

Patricia H. McNamara, MRCPUK, PhD1; Jennifer Williams, MRCPI1; Dominick J. H. McCabe, PhD, FRCPI2,3; Richard A. Walsh, MD, MRCPI1
[+] Author Affiliations
1Department of Neurology, Movement Disorders Unit, and Stroke Service, The Adelaide and Meath Hospital and Trinity College, Dublin, incorporating the National Children’s Hospital, Dublin, Ireland
2Academic Unit of Neurology, School of Medicine, Trinity College, Dublin, Ireland
3Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, England
JAMA Neurol. 2016;73(2):234-235. doi:10.1001/jamaneurol.2015.2201.
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This case report describes of a man in his 70s with known alcohol dependence syndrome whose neuroimaging revealed a striking triangular central pontine defect in keeping with central pontine myelinolysis.

A man in his 70s with known alcohol dependence syndrome was admitted to our institution after he was found collapsed at home. He reportedly consumed more than 1 bottle of liquor daily for several years. On general examination, he was unkempt and had a low body mass index consistent with his poor nutritional status. Neurological examination revealed gaze-evoked nystagmus in all directions, severe dysarthria, limb and truncal ataxia, and extensor plantars.

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Figure.
Magnetic Resonance Imaging and Computerized Tomographic Imaging Findings of Central Pontine Myelinolysis

A, Computed tomography of the brain demonstrating well-defined central pontine hypodensity. B and C, Axial (B) and sagittal (C) T2-weighted magnetic resonance imaging of brainstem confirming extensive pontine cavitation with typical tegmental sparing attributed to alcohol-related central pontine hypodensity.

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