A case of mistaken identity: Alcohol withdrawal, schizophrenia, or central pontine myelinolysis?

Paul Schneider, Vicki Allene Nejtek, Cheryl L. Hurd

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Demyelination is a hallmark of central pontine myelinolysis (CPM). Neuropsychiatric manifestations of this condition include weakness, quadriplegia, pseudobulbar palsy, mood changes, psychosis, and cognitive disturbances. These psychiatric symptoms are also associated with schizophrenia and alcohol withdrawal. Thus, it is clinically relevant to differentiate between CPM, schizophrenia, and alcohol withdrawal as the treatment and prognostic outcomes for each diagnosis are distinct. We present a series of events that led to a misdiagnosis of a patient admitted to the medical emergency center presenting with confusion, psychomotor agitation, and delirium who was first diagnosed with schizophrenia and alcohol withdrawal by emergency medical physicians and later discovered by the psychiatric consult team to have CPM. With a thorough psychiatric evaluation, a review of the laboratory results first showing mild hyponatremia (127 mmol/L), subsequent hypernatremia (154 mmol/L), and magnetic resonance brain imaging, psychiatrists concluded that CPM was the primary diagnosis underlying the observed neuropsychopathology. This patient has mild impairments in mood, cognition, and motor skills that remain 12 months after her emergency-center admission. This case report reminds emergency clinicians that abnormal sodium metabolism can have long-term and devastating psychopathological and neurological consequences. Differentiating between CPM, schizophrenia, and alcohol withdrawal using neuroimaging techniques and preventing the risks for CPM using slow sodium correction are paramount.

Original languageEnglish
Pages (from-to)49-54
Number of pages6
JournalNeuropsychiatric Disease and Treatment
Volume8
DOIs
StatePublished - 14 Feb 2012

Fingerprint

Central Pontine Myelinolysis
Schizophrenia
Alcohols
Psychiatry
Emergencies
Neuroimaging
Pseudobulbar Palsy
Sodium
Hypernatremia
Confusion
Psychomotor Agitation
Quadriplegia
Motor Skills
Delirium
Hyponatremia
Demyelinating Diseases
Diagnostic Errors
Psychotic Disorders
Cognition
Magnetic Resonance Imaging

Keywords

  • Alcohol
  • Central pontine myelinolysis
  • Hyponatremia
  • MRI
  • Schizophrenia

Cite this

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A case of mistaken identity : Alcohol withdrawal, schizophrenia, or central pontine myelinolysis? / Schneider, Paul; Nejtek, Vicki Allene; Hurd, Cheryl L.

In: Neuropsychiatric Disease and Treatment, Vol. 8, 14.02.2012, p. 49-54.

Research output: Contribution to journalArticle

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