Central Pontine Myelinolysis in a Normonatremic Patient with Depression
Yu Chia Liu 1, 2, Yen Kuang Yang 1, 3, 4, Po See Chen 1, 3, 5, Wei Hung Chang 1, 5*
1Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, 2Department of Psychiatry, Tainan Municipal Hospital (managed by Show Chwan Medical Care Corporation), Tainan, Taiwan, 3Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, 4Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan, 5Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
Received: October 6, 2020; Revised: December 7, 2020; Accepted: December 15, 2020; Published online: December 15, 2020.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
A 76-year-old male presented with a recurrent depressive episode, an unsteady gait and cognitive impairment. Extensive blood tests, including hemogram, biochemical tests, folic acid, vitamin B12, and thyroid hormone, showed normal results. With the exception of the unsteady gait, neurological examination was negative. Brian MRI showed the typical feature of central pontine myelinolysis (CPM); however, there was no history of alcoholism, liver transplantation, malnutrition or rapid correction of hyponatremia. The patient had taken venlafaxine to treat major depressive disorder for more than 20 years. After discontinuation of venlafaxine, the unsteady gait gradually resolved, and subsequent MRI revealed reduction of the lesions over 6 months. We discuss herein the possible correlation between chronic use of venlafaxine and CPM.
Keywords: central pontine myelinolysis, normonatremia, venlafaxine


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