MRI Findings of Central Pontine and Extrapontine Myelinolysis Related to Rapid Correction of Hyponatremia: Case Report

We report on a patient who developed central pontine myelinolysis and extrapontine myelinolysis after rapid correction of hyponatremia. He suffered open leg fracture, received operative room internal fixation, and followed by occurrence of hyponatremia. The hyponatremia was reestablished to normal levels by rapid infusion of normal saline solution over four days. Following this, he developed dysphagia, dysarthria, apathy, restlessness, and weakness in his limbs. An MRI showed symmetrical, hyperintense lesion in the pons and bilateral symmetric hyperintense lesions in the basal ganglia on T2-weighted images. After supportive treatment, the patient fully recovered without disability. Serial MRI showed complete resolution of the initial pontine and extrapontine changes.