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A Case of Alcohol Withdrawal-Induced Central and Extrapontine Myelinolysis

A 40-year-old female with a history of chronic alcohol use disorder presented with an acute intractable left-sided headache for three days and progressively worsening unsteady gait requiring a wheelchair to ambulate. The patient had a history of chronic alcoholism since 2019 but reported abstinence...

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Detalles Bibliográficos
Autores principales: Jamil, Maria, Salam, Abdus, Joseph Benher, Belinda M, Rehman, Sheema, Jamil, Javairia, Suleyman, Geehan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411381/
https://www.ncbi.nlm.nih.gov/pubmed/37565130
http://dx.doi.org/10.7759/cureus.41640
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author Jamil, Maria
Salam, Abdus
Joseph Benher, Belinda M
Rehman, Sheema
Jamil, Javairia
Suleyman, Geehan
author_facet Jamil, Maria
Salam, Abdus
Joseph Benher, Belinda M
Rehman, Sheema
Jamil, Javairia
Suleyman, Geehan
author_sort Jamil, Maria
collection PubMed
description A 40-year-old female with a history of chronic alcohol use disorder presented with an acute intractable left-sided headache for three days and progressively worsening unsteady gait requiring a wheelchair to ambulate. The patient had a history of chronic alcoholism since 2019 but reported abstinence since September 2021. One month after quitting alcohol, she experienced a sudden deterioration in bilateral extremity neuropathy, forgetfulness, difficulty writing, and severe mood swings, which continued to worsen until her presentation in July 2022. Laboratory tests, including complete blood count and electrolyte levels, were within normal ranges. A previous MRI performed during the investigation for alcoholic neuropathy a few months before she quit drinking showed no abnormalities. However, a subsequent MRI during work-up for the current acute symptoms revealed significant signal abnormalities involving the central pons, bilateral cerebral peduncles, and medullary pyramids, consistent with chronic central pontine myelinolysis (CPM) with extrapontine myelinolysis (EPM) extending into the peduncles. The patient received treatment with folate and multivitamins and was scheduled for outpatient follow-up with physical therapy for rehabilitation. This case highlights CPM as a consequence of alcohol withdrawal and emphasizes the importance of timely diagnosis and appropriate management in such patients.
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spelling pubmed-104113812023-08-10 A Case of Alcohol Withdrawal-Induced Central and Extrapontine Myelinolysis Jamil, Maria Salam, Abdus Joseph Benher, Belinda M Rehman, Sheema Jamil, Javairia Suleyman, Geehan Cureus Internal Medicine A 40-year-old female with a history of chronic alcohol use disorder presented with an acute intractable left-sided headache for three days and progressively worsening unsteady gait requiring a wheelchair to ambulate. The patient had a history of chronic alcoholism since 2019 but reported abstinence since September 2021. One month after quitting alcohol, she experienced a sudden deterioration in bilateral extremity neuropathy, forgetfulness, difficulty writing, and severe mood swings, which continued to worsen until her presentation in July 2022. Laboratory tests, including complete blood count and electrolyte levels, were within normal ranges. A previous MRI performed during the investigation for alcoholic neuropathy a few months before she quit drinking showed no abnormalities. However, a subsequent MRI during work-up for the current acute symptoms revealed significant signal abnormalities involving the central pons, bilateral cerebral peduncles, and medullary pyramids, consistent with chronic central pontine myelinolysis (CPM) with extrapontine myelinolysis (EPM) extending into the peduncles. The patient received treatment with folate and multivitamins and was scheduled for outpatient follow-up with physical therapy for rehabilitation. This case highlights CPM as a consequence of alcohol withdrawal and emphasizes the importance of timely diagnosis and appropriate management in such patients. Cureus 2023-07-10 /pmc/articles/PMC10411381/ /pubmed/37565130 http://dx.doi.org/10.7759/cureus.41640 Text en Copyright © 2023, Jamil et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Internal Medicine
Jamil, Maria
Salam, Abdus
Joseph Benher, Belinda M
Rehman, Sheema
Jamil, Javairia
Suleyman, Geehan
A Case of Alcohol Withdrawal-Induced Central and Extrapontine Myelinolysis
title A Case of Alcohol Withdrawal-Induced Central and Extrapontine Myelinolysis
title_full A Case of Alcohol Withdrawal-Induced Central and Extrapontine Myelinolysis
title_fullStr A Case of Alcohol Withdrawal-Induced Central and Extrapontine Myelinolysis
title_full_unstemmed A Case of Alcohol Withdrawal-Induced Central and Extrapontine Myelinolysis
title_short A Case of Alcohol Withdrawal-Induced Central and Extrapontine Myelinolysis
title_sort case of alcohol withdrawal-induced central and extrapontine myelinolysis
topic Internal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411381/
https://www.ncbi.nlm.nih.gov/pubmed/37565130
http://dx.doi.org/10.7759/cureus.41640
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