A Rare Case of Acute Psychosis as an Isolated Manifestation of Extrapontine Myelinolysis
Wan Aliaa Wan Sulaiman *
Faculty of Medicine and Health Science, University Putra Malaysia, 43400, Serdang Selangor, Malaysia.
Fan Kee Hoo
Faculty of Medicine and Health Science, University Putra Malaysia, 43400, Serdang Selangor, Malaysia.
Hamidon Basri
Faculty of Medicine and Health Science, University Putra Malaysia, 43400, Serdang Selangor, Malaysia.
Shariful Hasan
Faculty of Medicine and Health Science, University Putra Malaysia, 43400, Serdang Selangor, Malaysia.
Sazlyna Mohd Sazlly Lim
Faculty of Medicine and Health Science, University Putra Malaysia, 43400, Serdang Selangor, Malaysia.
Yoke Loong Foo
Faculty of Medicine and Health Science, University Putra Malaysia, 43400, Serdang Selangor, Malaysia.
Siew Mooi Ching
Faculty of Medicine and Health Science, University Putra Malaysia, 43400, Serdang Selangor, Malaysia.
Ramachandran Vasudevan
Institute of Gerontology, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
Mohd Hazmi Mohamed
Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia.
Hasnur Zaman Hashim
Kulliyyah of Medicine, International Islamic University Malaysia, Bandar Indera Mahkota Campus, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang, Malaysia.
*Author to whom correspondence should be addressed.
Abstract
Aims and Background: Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are recognized as osmotic demyelination syndrome (ODS). ODS is pathologically characterized by non-inflammatory demyelination of several brain structures with sparing of axons. This condition is usually associated with overzealous correction of hyponatraemia. Acute psychosis as the sole clinical manifestation is extremely rare.
Presentation of Case: Hence, we report an interesting case of a middle-aged man who was diagnosed with EPM, following rapid correction of hyponatraemia and subsequently developed acute psychosis. He made a good recovery with supportive treatment alone.
Discussion and Conclusion: The possibility of psychosis as a manifestation of ODS, particularly in patients with recent correction of hyponatraemia. The rate of correction of plasma sodium level is the key point for preventing ODS and its complications.
Keywords: Osmotic demyelination syndrome, extrapontine myelinolysis, hyponatraemia, psychosis.