Abstract Details

Title Acute Progressive Supranuclear Palsy Syndrome Secondary to Pontine Myelinolysis: A Case Report

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P06 - (-)

Poster/Presentation
Number 238

Objective

Background BACKGROUND: Centropontine and/or extrapontine myelinolysis (CPM and EPM) are considered to have poor prognosis. Extrapyramidal involvement have been described with CPM and EPM, but the pathophysiology is poorly understood, and the prognosis is unpredictable.

Design/Methods DESIGN/METHODS: A 63-year-old man with a history of chronic peripheric adrenal insufficieny was admitted to intensive care unit because of confusional state and severe hyponatremia (96 mmol/l). The correction fo hyponatremia was slow, following usual recommandations. Five days after correction of hyponatremia, the patient developed severe and progressive PSP-phenotype parkinsonism with rigidity, akinesia, supranuclear gaze palsy, dysphagia and frontal release signs. Initial brain MRI, lumbar puncture, DAT scan were normal. Brain MRI 2 weeks after onset of symptoms showed discrete lesions of CPM, there was no lesion of basal ganglia.

Results RESULTS: The patient showed almost complete recovery at 3 months follow-up, with a normal brain MRI.

Conclusions CONCLUSIONS: CPM and/or EPM can occur even when the recommandation for hyponatremia correction is followed. CPM with EPM can manifest as severe parkinsonism without pyramidal involvement. The outcome is often good and depends mainly on secondary complications. Clinicians should take the potentially good prognosis into consideration and treat complications intensively.

Authors/Disclosures
PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Richard Levy (La Pitie Salpetriere)	Richard Levy has nothing to disclose.
Beatrice Garcin	No disclosure on file

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