Central pontine myelinolysis associated with eye movement “bobbing”: case report

Abstract

ABSTRACT

Introduction: Central pontine myelinolysis (CPM) is an acute demyelinating disease caused by abrupt fluctuations in serum osmolality, which results in symmetrical demyelination of the central part of the base of the pons. Description: A 60-year-old patient was admitted to the Emergency Room of a hospital in the Federal District, with mental confusion that started 07 days ago, with no other complaints. On physical examination, he was in regular general condition, Glasgow 12, with mental confusion, normotensive, normocardio and afebrile. Isochoric pupils, photoragenfe, without neck stiffness, quadriplegia sequel to spinal cord trauma 33 years ago. She denied comorbidities and did not use continuous medication. His cranial CT performed on the 10th day after sensorium lowering showed diffuse and symmetrical hypodensity in the bridge associated with edema, with effacement of the peripontine cisterns. Due to the instability of the condition, the patient was unable to perform the cranial magnetic resonance exam. On neurological examination after removal of sedation and weaning from anticonvulsants, he presented vertical eye movement with rapid downward movement of the eyes, followed by a slow return to the initial position, called “BOBBING”. The etiology of severe hyponatremia has not been elucidated. The patient progressed to death.

Conclusions: Central pontine myelinolysis is a demyelinating pathology of the brain mainly associated with rapid correction of hyponatremia, manifesting especially as spastic tetraparesis and pseudobulbar palsy. The evolution of these patients varies from full recovery without sequelae to death, generally having a slow and gradual recovery.