Slowly progressive dystonia following central pontine and extrapontine myelinolysis

A 28-year-old woman was hospitalized with dysarthria and oro-mandibular and upper limb dystonia. Approximately 8 years prior to the current admission, the woman became severely hyponatremic due to traumatic subarachnoid hemor rhage-related SIADH, Brain MRIs showed a signal increase in the central pen s, thalamus and striatum on T2 weighted images compatible with central pont ine and extrapontine myelinolysis. From a few months after that event, dyst onia progressed slowly over the subsequent 8 years. We speculate that the p articular damage chiefly to the myelin structures by myelinolytic process m ay have caused an extremely slow plastic reorganization of the neural struc tures. giving rise to progressive dystonia.