Bulbar paralysis in chronic alcoholism with recovery. A case report with discussion of possible etiologic factors.

A 47-year-old chronic alcoholic with acute onset of spastic bulbar paralysis and quadriparesis with recovery has been reported. The differential diagnosis of occurrence of bulbar symptoms in an alcoholic has been discussed. It is postulated that on anatomical and clinical grounds this case probably represents the occurrence of central pontine myelinolysis with recovery. Attention has been drawn to recent literature in which the importance of vascular insufficiency, hypotension and disturbance of fluid and electrolyte balance in the occurrence of irreversible myelinolytic lesions has been stressed. It is postulated that the recovery of this patient from a seemingly inexorably progressive lesion was the result of prompt reversal of etiologic factors which result in central pontine myelinolysis-like, fluid and electrolyte imbalance, hypotension and vascular insufficiency.