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

Paul Schneider1, Vicki A Nejtek2,3, Cheryl Hurd2,31Green Oaks Behavioral Health Care Services, Dallas, 2University of North Texas Health Science Center, Fort Worth, 3John Peter Smith Health Network, Fort Worth, Texas, USAAbstract: Demyelination is a hallmark of central pontine myelinolysis (CPM). Ne...

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Autores principales:	Schneider P, Nejtek VA, Hurd CL
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2012
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/b46f81a29c4941acb6990f029589f093
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spelling	oai:doaj.org-article:b46f81a29c4941acb6990f029589f0932021-12-02T05:28:23ZA case of mistaken identity: alcohol withdrawal, schizophrenia, or central pontine myelinolysis?1176-63281178-2021https://doaj.org/article/b46f81a29c4941acb6990f029589f0932012-02-01T00:00:00Zhttp://www.dovepress.com/a-case-of-mistaken-identity-alcohol-withdrawal-schizophrenia-or-centra-a9189https://doaj.org/toc/1176-6328https://doaj.org/toc/1178-2021Paul Schneider1, Vicki A Nejtek2,3, Cheryl Hurd2,31Green Oaks Behavioral Health Care Services, Dallas, 2University of North Texas Health Science Center, Fort Worth, 3John Peter Smith Health Network, Fort Worth, Texas, USAAbstract: 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.Keywords: MRI, alcohol, schizophrenia, central pontine myelinolysis, hyponatremiaSchneider PNejtek VAHurd CLDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2012, Iss default, Pp 49-54 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Schneider P Nejtek VA Hurd CL A case of mistaken identity: alcohol withdrawal, schizophrenia, or central pontine myelinolysis?
description	Paul Schneider1, Vicki A Nejtek2,3, Cheryl Hurd2,31Green Oaks Behavioral Health Care Services, Dallas, 2University of North Texas Health Science Center, Fort Worth, 3John Peter Smith Health Network, Fort Worth, Texas, USAAbstract: 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.Keywords: MRI, alcohol, schizophrenia, central pontine myelinolysis, hyponatremia
format	article
author	Schneider P Nejtek VA Hurd CL
author_facet	Schneider P Nejtek VA Hurd CL
author_sort	Schneider P
title	A case of mistaken identity: alcohol withdrawal, schizophrenia, or central pontine myelinolysis?
title_short	A case of mistaken identity: alcohol withdrawal, schizophrenia, or central pontine myelinolysis?
title_full	A case of mistaken identity: alcohol withdrawal, schizophrenia, or central pontine myelinolysis?
title_fullStr	A case of mistaken identity: alcohol withdrawal, schizophrenia, or central pontine myelinolysis?
title_full_unstemmed	A case of mistaken identity: alcohol withdrawal, schizophrenia, or central pontine myelinolysis?
title_sort	case of mistaken identity: alcohol withdrawal, schizophrenia, or central pontine myelinolysis?
publisher	Dove Medical Press
publishDate	2012
url	https://doaj.org/article/b46f81a29c4941acb6990f029589f093
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_version_	1718400370878709760

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

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