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Case Reports in Neurological Medicine
Volume 2012 (2012), Article ID 327058, 3 pages
Case Report

Extrapontine Myelinolysis-Induced Parkinsonism in a Patient with Adrenal Crisis

1Neurology Section, Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
2Division of Neurology, University of Alberta, Edmonton, AB, Canada

Received 7 November 2012; Accepted 2 December 2012

Academic Editors: A. Fasano, D. B. Fee, and H. Ikeda

Copyright © 2012 Yahia Z. Imam et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Extrapontine myelinolysis (EPM) has been well described in the presence of rapid correction of hyponatremia. It is seldom reported with adrenal insufficiency. We report a unique case where a patient developed EPM as a result of adrenal insufficiency where the brain MRI revealed symmetrical lesion in the basal ganglia with pallidal sparing. Case Report. A 30-year-old gentleman with panhypopituitarism developed adrenal crisis, hyponatremia, and hyponatremic encephalopathy. Seven days after the rapid correction of hyponatremia, he developed parkinsonism and neuropsychiatric symptoms. MRI showed extrapontine myelinolysis without central pontine myelinolysis. Conclusion. Extrapontine myelinolysis without central pontine myelinolysis is rare and should raise a concern of associated adrenal insufficiency in the right clinical setting. Rapid correction of hyponatremia particularly in steroid-deficient states should be avoided as it can predispose to extrapontine myelinolysis. Magnetic resonance imaging is very helpful in supporting the diagnosis of EPM.