Extensive Central and Extrapontine Myelinolysis in a Case of Chronic Alcoholism without Hyponatremia: A Case Report with Analysis of Serial MR Findings

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We observed a 41-year-old woman with severe central pontine myelinolysis (CPM) and unusually extensive extrapontine myelinolysis (EPM), but without evidence of hyponatremia. Increased alcohol consumption in prior months was the main cause of her CPM/EPM. However, in general, EPM is a rare accompaniment in alcoholic patients with CPM without hyponatremia. With regard to our patient, the EPM was unusually widespread; magnetic resonance imaging (MRI) of her brain showed multiple hyperintense lesions on T2-weighted images distributed symmetrically in bilateral caudate nuclei, lentiform nuclei and thalami. Serial follow-up MRI revealed almost complete resolution of EPM after methylprednisolone pulse therapy. By contrast, marked cavitary hypointensity in the pons remained, but complete remission of neurological symptoms was achieved.