# Central Pontine Myelinolysis: A Rare and Life-Threatening Adverse Effect of Clobazam and Quetiapine

## TL;DR

A rare neurological condition called central pontine myelinolysis was linked to two medications in a patient without electrolyte issues.

## Contribution

This case highlights that clobazam and quetiapine can cause CPM even without hyponatremia.

## Key findings

- MRI confirmed central pontine myelinolysis in a patient on clobazam and quetiapine.
- Discontinuation of the medications led to clinical improvement.
- The case suggests medication-induced CPM can occur without electrolyte abnormalities.

## Abstract

Central pontine myelinolysis (CPM) is a rare neurological disorder characterized by demyelination within the central portion of the pons. While hyponatremia is a well-known precipitating factor, other etiologies, including medication use, have been reported. We present a case of a 69-year-old male with a history of obsessive-compulsive disorder, stroke, and type 2 diabetes mellitus who developed confusion, altered sensorium, and weakness in all four limbs. An MRI brain imaging revealed characteristic findings suggestive of CPM. Despite normal serum sodium levels, discontinuation of clobazam and quetiapine, medications taken by the patient, led to clinical improvement. This case underscores the importance of considering medication-induced CPM in the differential diagnosis of patients presenting with neurological symptoms, even in the absence of electrolyte abnormalities.