Extrapontine Myelinolysis in a patient with Primary Adrenal Insufficiency.

PURPOSE To report the development of estrapontine myelinolysis (EPM) in a patient with adrenal insufficiency and review similar in the literature. CASE REPORT A 49-year-old female with insufficiency presented with acute dysarthria, stuttering, and parkinsonism. She received isotonic saline hydration for adrenal crisis and hyponatremia 18 days before the onset of symtoms. The brain MRI and MRS showed demyelination at bilateral basal ganglia and the thalamus, which was compatible with EPM and resolved within 3 months after steroid treatment. CONCLUSION Development of acute parkinsonism after rapid correction of hyponatremia may indicate the occurrence of EPM and underlying adrenal insufficiency should be excluded in these patients.