Locked-in Syndrome due to Central Pontine Myelinolysis: Case Report.

[locked-in syndrome]

Central pontine myelinolysis (CPM ) classically occurs in alcoholics , malnourished individuals , chronic liver diseases , and rapid correction of hyponatremia . This report presents locked-in syndrome due to CPM following rapid correction of hyponatremia . A 44 -year -old male came to the hospital due to a short period of loss of consciousness . He was alert and had no focal neurological abnormalities at admission . The serum sodium concentration was 118 mEq /L and was corrected to 134 mEq /L in the first 18 hours . One week later , progressive weakness in limbs developed and he progressed to a complete quadriplegic state and bulbar palsy , with only eye blinking preserved . Brain magnetic resonance imaging revealed a characteristic hyperintense signal abnormality in both pons , so he was diagnosed to locked-in syndrome caused by CPM . The patient gradually improved following continuous intensive rehabilitation for more than 2 years . He was able to move all joint muscles against gravity in generally and he could gait under supervision .