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Título

Osmotic Myelinolysis Associated with Psychogenic Polydipsia: Case Report

RESUMO

Case presentation: Patient with psychogenic polydipsia evolving with hyponatremia, correction of serum sodium levels, and consequent episode of altered level of consciousness. Years later, magnetic resonance imaging showed features of extrapontine myelinolysis. Such lesions were distributed exclusively in the corticosubcortical regions, mainly in the temporal region of the right hemisphere, but also affecting the right parietal region and the left temporal region. Discussion: Osmotic myelinolysis (OM) is classified into 3 groups: central pontine myelinolysis (CPM) without extrapontine involvement, extrapontine myelinolysis (EPM) without the involvement of pontine sites, and a form of central pontine myelinolysis with extrapontine involvement (CPM+EPM). The extrapontine form affects regions such as the putamen, thalamus, caudate nucleus, external capsule, and, more rarely, corticosubcortical regions. Isolated cases of corticosubcortical involvement are extremely rare in the literature. The clinical presentation of patients affected by this disease is quite variable, and the use of magnetic resonance imaging is extremely important to confirm the diagnosis. This pattern of exclusive corticosubcortical involvement was identified and well analyzed in an autopsy study, but it lacks reports on its radiological features. Final comments: As the clinical presentation of OM is nonspecific and the radiological aspect can be characteristic, knowing the different imaging patterns is of paramount importance to narrow the differential diagnosis for the various professionals who may face this type of disease, such as neurologists, psychiatrists, emergency physicians, intensivists, among others. It is hoped that this case report will provide an expansion of knowledge about this rare condition, generating an eventual diagnostic and therapeutic optimization for future cases.

Palavras Chave

Extrapontine myelinolysis. Psychogenic polydipsia. Magnetic Resonance Imaging