We report a patient admitted with severe dyspnea due to bilateral vocal fold immobility (BVFI), associated with hyponatremia and pneumonia that required emergency tracheotomy. Cerebral magnetic resonance imaging showed a pons lesion compatible with central pontine myelinolysis. Hyponatremia is thought to be caused by hypovolemia. The hyponatremia, and not its correction, is speculated to be the cause of central pontine myelinolysis in this patient. To our knowledge, this is the first case reported of a bilateral vocal fold immobility caused by central pontine myelinolysis induced by hyponatremia. Laryngoscope, 2010.