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September 1988, Vol 45, No. 9 >
Article | September 1988

Pathologic Crying as a Prominent Behavioral Manifestation of Central Pontine Myelinolysis

J. J. Van Hilten, MD; O. J. S. Buruma, MD; P. Kessing, MD; L. T. Vlasveld, MD
Arch Neurol. 1988;45(9):936-936. doi:10.1001/archneur.1988.00520330010001
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To the Editor.  —Recently, Price and Mesulam1 drew attention to the behavioral manifestations of central pontine myelinolysis (CPM). In addition, we report a case of pathologic crying that developed several days after the rapid correction of hyponatremia.

Report of a Case.  —A 45-year-old man was admitted to the hospital because of Wernicke's encephalopathy, malnutrition, and dehydration. Laboratory data showed a serum sodium level of 116 mmol/L and a moderate uremia due to inadequate salt and water intake and chronic vomiting. During the first 24 hours, 3 L of 0.9% saline solution was infused. Treatment with 300 mg of thiamine hydrochloride, administered intramuscularly daily, was started. The serum sodium level gradually increased to a value of 132 mmol/L. However, during the following days, he developed emotional lability and difficulty in swallowing. Examination revealed that the patient was slow of thought, inattentive, and frequently cried spasmodically. Smooth pursuit of eye movements

REFERENCES

1 +
Price BH, Mesulam MM:  Behavioral manifestations of central pontine myelinolysis . Arch Neurol 1987;;44:671-673.
2 +
Poeck K:  Pathophysiology of emotional disorders associated with brain damage , in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology . New York, North Holland Publishing Co, 1969;, vol 3, pp 363-365.
3 +
Tatemichi TK, Nichols FT, Mohr JP:  Pathological crying: A pontine pseudobulbar syndrome . Ann Neurol 1987;;22:133.
4 +
Ayus JC, Krothapalli RK, Arieff AI:  Treatment of symptomatic hyponatremia and its relation to brain damage: A prospective study . N Engl J Med 1987;;317:1190-1195.
5 +
Sterns RH:  Severe symptomatic hyponatremia: Treatment and outcome: A study of 64 cases . Ann Intern Med 1987;;107:656-664.

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1 +
Price BH, Mesulam MM:  Behavioral manifestations of central pontine myelinolysis . Arch Neurol 1987;;44:671-673.
2 +
Poeck K:  Pathophysiology of emotional disorders associated with brain damage , in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology . New York, North Holland Publishing Co, 1969;, vol 3, pp 363-365.
3 +
Tatemichi TK, Nichols FT, Mohr JP:  Pathological crying: A pontine pseudobulbar syndrome . Ann Neurol 1987;;22:133.
4 +
Ayus JC, Krothapalli RK, Arieff AI:  Treatment of symptomatic hyponatremia and its relation to brain damage: A prospective study . N Engl J Med 1987;;317:1190-1195.
5 +
Sterns RH:  Severe symptomatic hyponatremia: Treatment and outcome: A study of 64 cases . Ann Intern Med 1987;;107:656-664.

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