Extrapontine myelinolysis in a patient with primary adrenal insufficiency

Purpose: To report the development of extrapontine myelinolysis (EPM) in a patient with adrenal insufficiency and review similar cases in the literature. Case Report: A 49-year-old female with adrenal insufficiency presented with acute dysarthria, stuttering, and parkinsonism. She received isotonic saline hydration for adrenal crisis and hyponatremia 18 days before the onset of symptoms. 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.