Cognition and functional performance in daily activities before and after pontine and extrapontine myelinolysis: A case study

Abstract

Central pontine and extrapontine myelinolysis (CPEM) is a rare neurological condition usually due to rapid correction of hyponatremia. CPEM is mainly characterized by motor deficits (typically quadraparesis or extrapyramidal features) but neurobehavioral symptoms were also reported in the literature. However, very few studies on the neuropsychological and functional performance in daily activities have been performed in this population. In this case study, a 55-year-old woman had neuropsychology and functional evaluations prior and after the first manifestations of CPEM. The patient presented motor impairments characterized by parkinsonism symptoms and decreased dexterity. Several neurobehavioral deficits were observed including emotional lability, impulsivity, altered judgment, and disinhibition. Executive dysfunctions and impulsivity were observed during neuropsychological and functional evaluations, limiting the patient's autonomy in complex activities of daily living. The patient recovered progressively from most motor, neurobehavioral and cognitive deficits.

Keywords:

• Pontine and extrapontine myelinolysis
• Neuropsychology
• Activities of daily living
• Executive functions
• Frontal lobe syndrome

Acknowledgments

The authors are grateful to the Department of Radiology of the Hôpital du Sacré-Coeur de Montréal for magnetic resonance images.