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

Neuropsychiatric Disease and Treatment
Paul SchneiderCheryl L Hurd

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 ...Continue Reading

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Citations

Mar 4, 2015·Asian Journal of Psychiatry·Rachel GogginDaphne Law
Oct 23, 2015·Palliative & Supportive Care·Sabitha AligetiFernando F Barrera

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Methods Mentioned

BETA
pharmacotherapy

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