Journal of Neurology

, Volume 242, Issue 7, pp 450–454 | Cite as

Regressive dystonia and cerebellar ataxia: two unusual symptoms in central pontine myelinolysis

  • Luc Defebvre
  • Pascal Rogelet
  • Alain Destée
  • Albert Verier
Original Communication
Received:
Accepted:

Abstract

Two patients with central pontine myelinolysis who presented with dystonia are described. In one, it was associated with cerebellar ataxia which spontaneously improved. In the second, dystonia progressively disappeared 6 months later. In both cases magnetic resonance imaging (MRI) revealed characteristic pontine lesions. Extrapontine myelinolysis involving the putamen was also observed in one patient. Even when the basal ganglia seem to be spared on MRI, dystonia is probably due to their involvement by myelinolysis. Cerebellar ataxia may be related to peduncular or cerebellar lesions or both.

Key words

Central pontine myelinolysis Dystonia Cerebellar ataxia 
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References

  1. 1.
    Adams RD, Victor M, Mancall EM (1959) Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients. Arch Neurol Psychiatry 81:154–172Google Scholar
  2. 2.
    Brunner JE, Redmond JM, Haggar AM, Elias SB (1988) Central Pontine myelinolysis after rapid correction of hyponatremia: a magnetic resonance imaging study. Ann Neurol 23:389–391PubMedGoogle Scholar
  3. 3.
    Burcar BJ, Norenberg MD, Yarnell PR (1977) Hyponatremia and central pontine myelinolysis. Neurology 27:223–226PubMedGoogle Scholar
  4. 4.
    Burke RE, Fahn S, Gold AP (1980) Delayed onset dystonia in patients with “static” encephalopathy. J Neurol Neurosurg Psychiatry 43:789–797PubMedGoogle Scholar
  5. 5.
    Clifford DB, Gado MH, Levy BK (1989) Osmotic demyelination syndrome. Lack of pathologic and radiologic imaging correlation. Arch Neurol 46:343–347PubMedGoogle Scholar
  6. 6.
    De Witt LD, Buonanno FS, Kistler JP, Zeffiro T, DcLapaz RL, Brady TJ, Rosen BR, Pykett IL (1984) Central pontine myelinolysis: demonstration by nuclear magnetic resonance. Neurology 34:570–576PubMedGoogle Scholar
  7. 7.
    Dickoff DJ, Raps M, Yahr MD (1988) Striatal syndrome following hyponatremia and its rapid correction: a manifestation of extrapontine myelinolysis confirmed by magnetic resonance imaging. Arch Neurol 45:112–114PubMedGoogle Scholar
  8. 8.
    Gille M, Jacquemin C, Kiame G, Delbecq J, Guilmot D, Depre A (1993) Myélinolyse centropontine avec ataxie cérébelleuse et dystonie. Rev Neurol (Paris) 5:344–346Google Scholar
  9. 9.
    Grafton ST, Bahls F, Bell KR (1988) Acquired focal dystonia following recovery from central Pontine myelinolysis. J Neurol Neurosurg Psychiatry 51:1354–1355PubMedGoogle Scholar
  10. 10.
    Kurlan R, Schoulson I (1989) Dystonia and akinetic-rigid features in central pontine myelinolysis (abstract). In: Program and abstracts. American Neurological Association 141Google Scholar
  11. 11.
    Maraganore DM, Folger WN, Swanson JW, Ahlskog JE (1992) Movement disorders as sequelae of central Pontine myelinolysis: report of three cases. Mov Disord 7:142–148PubMedGoogle Scholar
  12. 12.
    McCoomb RD, Pfeiffer RF, Casey JH, Wolcoot G, Till DJ (1989) Lateral pontine and extrapontine myelinolysis associated with hypernatraemia and hyperglycemia. Clin Neuropathol 8:284–288PubMedGoogle Scholar
  13. 13.
    Pettigrew LC, Jankovic J (1985) Hemidystonia: a report of 22 patients and a review of the literature. J Neurol Neurosurg Psychiatry 48:650–657PubMedGoogle Scholar
  14. 14.
    Salerno SM, Kurlan R, Joy SE, Shoulson I (1993) Dystonia in central pontine myelinolysis without evidence of extrapontine myelinolysis. J Neurol Neurosurg Psychiatry 56:1221–1223PubMedGoogle Scholar
  15. 15.
    Stam J, Van Oers MHJ, Verbeeten B Jr (1984) Recovery after central Pontine myelinolysis. J Neurol 231:52–53PubMedGoogle Scholar
  16. 16.
    Steller U, Koschorek F, Strenge H (1988) Cerebellar ataxia with recovery related to central Pontine myelinolysis. J Neurol 235:379–381PubMedGoogle Scholar
  17. 17.
    Stockard JJ, Rossiter VS, Wiederholt WC, Kobayashi RM (1986) Brain-stem auditory evoked responses in suspected central pontine myelinolysis. Arch Neurol 33:726–728Google Scholar
  18. 18.
    Telfer RB, Miller EM (1979) Central pontine myelinolysis: demonstrating by computerised tomography. Ann Neurol 6:455–456PubMedGoogle Scholar
  19. 19.
    Thompson PD, Miller D, Gledhill RF, Rossor MN (1989) Magnetic resonance imaging in central pontine myelinolysis. J Neurol Neurosurg Psychiatry 52:675–677PubMedGoogle Scholar
  20. 20.
    Tinker R, Anderson MG, Anand P, Kermode A, Harding AE (1990) Pontine myelinolysis presenting with acute parkinsonism as a sequel of corrected hyponatraemia. J Neurol Neurosurg Psychiatry 53:87–88Google Scholar
  21. 21.
    Tison FX, Ferrer X, Julien J (1991) Delayed onset movement disorders as a complication of central pontine myelinolysis. Mov Disord 6:171–173PubMedGoogle Scholar
  22. 22.
    Weismann JD, Weismann BM (1989) Pontine myelinolysis and delayed encephalopathy following the rapid correction of acute hyponatremia. Arch Neurol 46:926–927PubMedGoogle Scholar
  23. 23.
    Wright DG, Laureno R, Victor M (1979) Pontine and extrapontine myelinolysis. Brain 102:361–385PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • Luc Defebvre
    • 1
  • Pascal Rogelet
    • 1
  • Alain Destée
    • 1
  • Albert Verier
    • 2
  1. 1.Service de Neurologie AHôpital B, CHRULilleFrance
  2. 2.Service de NeurologieCentre Hospitalier Dr SchaffnerLensFrance

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