Orolingual dyskinesia in central pontine myelinolysis.

A 64-year-old housewife presented with involuntary movements of the lips and tongue for one month. Recently her mood became more labile, tended to be worry and had frequent nightmares. She was in her usual health until one year ago when she had diabetes diagnosed and noticed mild jaw tremor after a traumatic experience involving a minor motorcycle accident. There were no family history of movement disorders and no history of taking psychiatric drugs, liver disease, severe head trauma, and neurological disorders such as stroke. General examination was unremarkable. Neurological examination revealed an intact mental status , but a decreased facial expression. There were continued irregularly rhythmic movements of the month and protruding of the tongue. There was mild jaw tremor. Speech was dysarthric. Bradykinesia and rigidity were absent. Gait was normal. Deep tendon reflexes were moderately increased. Plantar response was flexor. Sensations were intact. Figure. MRI T2-weighted images revealed a hypertense pontine lesion occupying mainly the basis pontis.