Central pontine myelinolysis presenting with depressive features

Abstract

Central pontine myelinolysis is defined as symmetric area of myelin disruption associated with rapid correction of hyponatremia. Clinical presentation is with flaccid paralysis, altered consciousness and often facial or bulbar weakness. Here we report this case of central pontine myelinolysis, who initially presented with symptoms of depression.CASE REPORT 45 year old female was referred for complaints of decreased appetite, decreased communication, sleep disturbance, crying spells for past 10 days from medicine ward where she was admitted for the same. She is a known case of Autosomal dominant polycystic kidney disease, treated for urosepsis in the nephrology ward, 20 days back .There was a past history of suicide   attempt five years back following interpersonal conflicts.  Physical   examination revealed stable vital parameters, brisk deep tendon reflexes in the neurological examination. She was found to be restless, irritable and answering in  monosyllables for most of the questions. Her attention was  arousable, but ill sustained .All the features mentioned above, were not consistent with a functional aetiology and neurologist opinion was sought. Neuroimaging revealed hyper intense lesions in the central pons, caudate nucleus and   Putamen,suggestive of central pontine myelinolysis.Conclusion The series of events presented here  highlight the need, to consider psycho pathological behaviors as sequel, of              electrolyte abnormalities. It is imperative to rule out  neurological and metabolic abnormalities before entertaining a psychiatric diagnosis in any patient.