Sequential observation of movement disorders and brain images in the case of central pontine myelinolysis and extrapontine myelinolysis.

Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are well recognized syndromes related to rapid correction of hyponatremia and have been reported to show a variety of movement disorders. However, sequential observation of movement disorders as well as brain images has seldom been reported. We report a case of CPM and EPM presenting with various sequential changes in movement disorders including delayed choreic movement over 11 months; we present sequential brain magnetic resonance images showing increased T1 and decreased fat-suppression T1 signal intensity. We suggest that delayed low signal intensity, in the fat-suppression T1-weighted images, is a result of the destruction of myelin and by products. Damage to the myelin may cause various movement disorders in a delayed manner.