Central Pontine Myelinolysis: About a Clinical Case in Niger and Literature Review

Abstract

Introduction: Centro pontine myelinolysis or osmotic demyelination syndrome was described in 1959. It is defined as centro-protuberantial edema, two to three days after rapid restoration of hyponatremia. We report a clinical case of centro-pontine myelinolysis in a context of severe hyponatremia, diagnosed in September 2019 at National Hospital of Amirou Boubacar Diallo of Niamey, on the basis of cerebral magnetic resonance imaging (MRI). Observation: A 41-year-old man with no previous history consulted the emergency department for acute non-febrile gastroenteritis and altered consciousness. The clinical course was marked by the onset of flaccid tetraplegia and bilateral pyramidal syndrome. Biological tests revealed severe hyponatremia at 96.8 mmol/l, which was corrected to 149 mmol/l in less than 72 hours, and hypokalemia at 2.80 mmol/l. A cerebral MRI was used to diagnose Centro pontine myelinolysis, showing T2-weighted and Flair-weighted hyper signals in the white matter, periventricularly and in the bulb, which progressed favorably under treatment with dexamethasone 8 mg/8 h. Conclusion: Centro pontine myelinolysis is a serious pathology that is difficult to manage in our regions.