Wide Central Pontine, Bulbar and Thalamic Myelinolysis with Sequela

Although cases of hyponatremia during pregnancy have been described, it has rarely been possible to show demyelination lesions in central pons, bulbus as well as thalamus, by imaging techniques. We report a case that developed extensive myelinolysis due to the "rapid" correction of hyponatremia as a result of hyperemesis gravidarum. Magnetic resonance imaging showed bilaterally symmetric hyper-intense areas in the thalamus and cerebral crus and symmetric hyperintense area in the central pons, with sparing of the rim. In the second day of hospitalization, probably as a result of expansion of myelinolysis, she was intubated and received mechanical ventilator due to bradypnea and a GCS scale of E1M4V2. She was extubated in 11(th) day of hospitalization and physical therapy was started. She was discharged in 30(th) day of hospitalization with a GCS of 15. But she was tetraparetic (2/5). In the 3(rd) month of follow up, her quadriparesis improved to paraparesis in lower extremities (3/5). Her follow up examinations in the first year did not change although physical therapies go on. She delivered a normal child.