A chronic alcoholic with central pontine myelinolysis: Victim of double hit

Central pontine myelinolysis (CPM), is a potentially fatal neurological disorder identified by demyelination at the bottom of the pons. Osmotic stress, endothelial dysfunction, blood–brain barrier damage, and rapid correction of hyponatremia believed to be the main causes. Chronic alcoholism may influence the CPM. We report a case of chronic alcoholism and normonatremia, who presented with sudden onset of drowsiness and quadriparesis, after sudden abstinence from alcohol who was eventually diagnosed with CPM. Evidence of elevated serum ammonia level indicated encephalopathy. Our case emphasizes that CPM can manifest in patients with chronic alcoholism. CPM must be distinguished from the natural course of alcohol withdrawal delirium and Wernicke's encephalopathy, which necessitates clinical astuteness and a high level of suspicion on the part of the physician.