Acute Osmotic Central Pontine Demyelination in an Alcoholic Patient With Normal Sodium Levels and a Vitamin B6 Deficiency.

We report a Native American male in his 50s with a complex medical history including alcohol use disorder and seizure disorder who presented with complaints of generalized weakness and multiple falls. The patient was admitted for altered mental status, community acquired pneumonia, sepsis, and bacteremia. On hospital day 23, the patient reported a sudden onset of sensation of food stuck in his upper chest. Brain MRI confirmed osmotic demyelination syndrome (ODS) within the central pons. Further workup revealed this finding was likely due to malnutrition, alcoholism, hypoalbuminemia, and vitamin B6 deficiency. However, the patient presented with normonatremia throughout his entire hospital stay. After acute onset of ODS, the patient was transferred to the ICU where he continued to decline. After 68 days from initial presentation, the patient died in hospice care from myelinolysis complications. This case demonstrates a case of ODS of the central pons in a patient with normonatremia, hypoalbuminemia, and severe vitamin B6 deficiency.

Gluten Ataxia and mGluR1 Autoimmune Encephalitis Presenting as Acute Cerebellar Ataxia: A Case Report.

A Caucasian male in his 60s presented with acute onset of dizziness, dysarthria, and gait ataxia. Upon extensive workup, positive findings were cerebrospinal fluid (CSF) showing lymphocytic pleocytosis with oligoclonal bands, positive celiac disease autoantibodies in blood, a duodenal biopsy indicating lymphocytic infiltration, and positive anti-mGluR1 antibody titers in CSF. The patient was started on a strict gluten-free diet and intravenous immunoglobulin therapy for 5 days and showed mild consecutive improvements each day of treatment. He was discharged after 22 days, and was encouraged to continue gluten adherence, physical and speech therapy, and follow up with neuroimmunology. This report demonstrates that autoimmune encephalitis due to anti-mGluR1antibodies and gluten ataxia are both immune-mediated disorders that should be considered in acute cerebellar ataxia cases. By broadening the differential diagnosis and a comprehensive CSF analysis, identification of gluten ataxia and autoimmune encephalitis were beneficial in the management of this particular patient.