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Annals of Physical and Rehabilitation Medicine
Volume 55, n° S1
page e200 (octobre 2012)
Doi : 10.1016/j.rehab.2012.07.507
Neuropsychologie (III) : communications Affichées / Neuropsychology (III): posters

Neuropsychological disorders in central pontine myelinolysis
 

C. Massot , M. Hache, V. Tiffreau
Service de MPR, hôpital Swynghedauw, CHRU de Lille, rue du Pr-Verhaegue, 59037 Lille, France 

Corresponding author.

Keywords : Central pontine myelinolysis, Neuropsychology, Hyponatremia


Introduction .– Central pontine myelinolysis or osmotic demyelinisation was first described by Adam et al. in 1959. This rare syndrome is caused by a rapid correction of chronic hyponatremia. Several risk factors are identified: alcoholism, malnutrition, kidney failure, hepatic disease, transplantation… The pathophysiological mechanisms are not well known: symmetrical non-inflammatory demyelinization in the pons would be induced by an osmotic stress caused by an overly rapid reversal of chronic hyponatremia. Clinical manifestations are variable. A spastic quadraparesia, pseudobulbar syndrome, dysarthria, dysphonia, or neuropsychological deficits are most common. Here, we report the case of a patient with neuropsychological disorders.

Case report .– A 52-year-old man with a past history of chronic alcoholism and smoking was admitted in an emergency context for deterioration of general status. A lung infection affecting the middle lobe complicated with kidney failure with hyperkaliemia at 7mmol/L and hyponatremia at 113mmol/L were found. Two successive cardiac arrests occurred; the second one lasted 15minutes. When the sedation was discontinued, the patient presented quadriparesia compatible with intensive-care polyneuropathy and post-intubation dysphona. The patient presented disorders of the short term memory, fantasizing, false recognition and perseveration. The neuropsychological tests revealed severe dysexecutive syndrome: inattention, short-term memory impairment, and alteration of the recovery process in verbal episodic memory. To investigate these deficits, an MRI was performed and revealed a hyposignal on the T1 sequence and a hypersignal on the T2 sequence in the centropontine area, suggestive of a myelolysis centropontine lesion.

Discussion .– The neuropsychological disturbances in central pontine myelinolysis syndrome are described in reviews: short-term memory deficit, an important distractibility, inattention, logorrhoea… This case report shows that mnesic disorders can be important in the clinical prsentation of osmotic demyelinisation. The neuropsychological impact of this disease can be difficult to distinguish from disorders related to alcoholism. The prognosis is uncertain. Cognitive disorders and their evolution should be investigated in patients presenting centropontine myelinolisis.


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