Neuropsychiatric and neuropsychological manifestations of central pontine myelinolysis

A patient with central pontine myelinolysis (CPM) underwent neurological an d mental status examination, as well as neuropsychological testing, during the acute stage of the disease. After correction of the hyponatremia, a gro ss change in his neuropsychiatric status was observed. The patient underwen t extensive neurological, psychiatric, and neuropsychological testing durin g the acute phase of the disease and at follow-up 4 months Inter. All major neurological and neuropsychiatric symptoms present nt onset were fully rev ersible. Neuropsychological examination revealed deficits in the domains of attention and concentration, short-term memory and memory consolidation, v isual motor and fine motor speeds, and learning ability. Although improved, neuropsychological testing still revealed remarkable deficits at follow-up . We conclude that neuropsychological deficits can accompany CPM, and that these deficits do not necessarily diminish simultaneously with the radiolog ical or clinical neurological findings but may persist for a longer period of time, or even become permanent. In his recovery the patient started to m anifest new neurological symptoms consisting of a mild resting tremor of bo th hands and slow choreoathetotic movements of the trunk and the head, whic h we considered to be late neurological sequelae of CPM. The significance o f CPM in the differential diagnosis of acute behavioral changes after corre ction of hyponatremia is stressed, even if correction is achieved slowly an d carefully. (C) 1999 Elsevier Science Inc.