Introduction: Central pontine myelinolysis (CPM) is a neurological condition with unknown pathogenesis. It is most often observed in patients suffering hydroelectrolyte disturbances. There is no specific treatment and it can have an unfortunate outcome. We present a case of CPM that responded well to immunoglobulins.
Case report: The case of a 31 year old female patient with bulimia, impulsive type personality, potomania and chronic alcoholism is presented. After admission to the intensive care unit due to severe hyponatremia (104 mEq/l) with correction in 7 days, she had a rapidly progressive picture of dysarthria and gait instability, tetraparesis and pyramidalism. Due to suspected CPM, emergency magnetic resonance imaging was requested, observing a hypertense lesion in central, bilateral and symmetric T2 of the pons. Treatment was initiated with dexamethasone with clinical progression so that i.v. immunoglobulin treatment was prescribed, with a spectacular improvement after the third day.
Conclusions: Treatment with immunoglobulins may be a therapeutic option to consider in patients with CPM and clinical progression after the usual treatment. Furthermore, this response opens questions on a possible dysimmune mechanism in this disease.