Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
CASE REPORTS
Rapid Development of Central Pontine Myelinolysis after Recovery from Wernicke Encephalopathy: A Non-alcoholic Case without Hyponatremia
Yuui KishimotoKen IkedaKiyoko MurataKiyokazu KawabeTakehisa HirayamaYasuo Iwasaki
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JOURNALS OPEN ACCESS

2012 Volume 51 Issue 12 Pages 1599-1603

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Abstract

We describe a non-alcoholic diabetic patient with central pontine myelinolysis (CPM) and Wernicke encephalopathy (WE). A 69-year-old man developed consciousness disturbance after parenteral hyperalimentation for liver abscess and sepsis. Neurological examination revealed drowsiness and no articulation. MRI disclosed T2-hyperintense lesions in the dorsal medulla oblongata and dentate nuclei, and symmetric enhancement in the inferior colliculus. Thiamine treatment (1,000 mg/day, div) attenuated neurological deficits. Seven days later, WE-related lesions were markedly regressed and a central pontine T2-hyperintensity lesion appeared. Serum sodium levels were normal. Physicians should pay more attention to rapid development of normonatremic CPM under thiamine supplementation in non-alcoholic WE patients.

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© 2012 by The Japanese Society of Internal Medicine
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