Key clinical features include:

• Altered mental status or encephalopathy (e.g., confusion, decreased consciousness, coma).[1][4-5]
• Dysarthria and dysphagia due to pseudobulbar palsy.[1-2][4-5]
• Quadriparesis or quadriplegia (classically from pontine involvement).[1-2][6]
• Movement disorders such as parkinsonism, dystonia, or chorea (especially with extrapontine myelinolysis).[1-2][4-5][7]
• Locked-in syndrome in severe cases, with preserved consciousness but complete paralysis except for vertical eye movements.[1-2][6]
• Other findings may include hyperreflexia, spasticity, limb weakness, and, rarely, seizures or status epilepticus.[1-3][8]

=/= Central Poutine demyelination (brain shrinking) (occur with hypernatremia)