Magnetic resonance imaging detection of a lesion compatible with central pontine myelinolysis in a pregnant patient with recurrent vomiting and confusion

The authors report a patient who presented with unexplained confusion. She was 15 weeks pregnant and had been having recurrent vomiting for several we eks. This was felt to possibly represent hyperemesis gravidarum, but she ha d several other possible contributing factors. Her serum sodium was 146 mmo l/L, and her potassium was 2.6 mmol/L. She was alert but had disorientation , visual hallucinations, memory impairment, and confabulation despite being a college graduate with no history of illicit drug use or excessive alcoho l consumption. Her initial magnetic resonance imaging (MRI) brain scan was interpreted as being normal. However, her follow-up MRI brain scan revealed typical findings of central pontine myelinolysis, which correlated with hy perreflexia and positive Babinski reflexes. This patient illustrates the co nstellation of signs and symptoms that can be seen with a demyelinating les ion of the pons. In addition, our case illustrates how this MRI scan findin g can be quite nonspecific but may help to explain the clinical findings.