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Case Reports in Neurological Medicine
Volume 2015 (2015), Article ID 421923, 2 pages
http://dx.doi.org/10.1155/2015/421923
Case Report

Central Pontine Myelinolysis with Minimal Hyponatremia in the Setting of AIDS

1Department of Internal Medicine, Johns Hopkins University, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
2Department of Neurology, Division of Neurocritical Care, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA

Received 20 July 2015; Accepted 18 October 2015

Academic Editor: Mathias Toft

Copyright © 2015 Joseph M. Carrington 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.

Abstract

Central pontine myelinolysis (CPM) is classically attributed to overly rapid correction of profound hyponatremia. However, there are case reports of this disease in the setting of normal serum sodium or minimal hyponatremia. These cases have been hypothesized to be secondary to other metabolic disturbances such as hyperglycemia or hypophosphatemia. Eunatremic CPM has also been described in patients with advanced acquired immune deficiency syndrome (AIDS). The mortality risk in this special population is significantly higher than those with hyponatremia-associated CPM, but the mechanisms are unclear. We discuss a case of a man with AIDS who developed CPM with minimal hyponatremia and no other metabolic disturbances. Common variables within this population, such as hypoalbuminemia and lymphoma, are discussed as potential factors contributing to the pathophysiology. Reporting these atypical cases is crucial to our understanding of how to prevent future cases.