| Central pontine myelinolysis | |
|---|---|
| Classification and external resources | |
 Pons labeled at bottom left |
|
| ICD-10 | G37.2 |
| DiseasesDB | 2198 |
| MedlinePlus | 000775 |
| eMedicine | neuro/50 |
| MeSH | D017590 |
Central pontine myelinolysis is a neurologic disease caused by severe damage of the myelin sheath of nerve cells in the brainstem, more precisely in the area termed the pons.
It can also occur outside the pons.[1] The term "osmotic demyelinization syndrome" is similar to "central pontine myelinolysis", but also includes areas outside the pons.[2]
Contents |
The most common cause is the rapid correction of low blood sodium levels (hyponatremia).[3]
It has been observed following hematopoietic stem cell transplantation.[4]
It is frequently associated with alcoholism. When alcoholics are treated for hyponatremia, an overly rapid rate of correction can lead to CPM.[5]
It can be associated with Hyperemesis gravidarum.
It can be difficult to identify using conventional imaging techniques.[6]
Imaging by MRI demonstrates an area of high signal return on T2 weighted images.
Frequently observed symptoms in this disorder are sudden para- or quadraparesis, dysphagia, dysarthria, diplopia and loss of consciousness. The patient may experience locked-in syndrome where cognitive function is intact, but all muscles are paralyzed with the exception of eye blinking.
Osmotic demyelination syndrome occurs with rapid correction of hyponatremia. It is characterized by acute paralysis, dysarthria, dysphagia and other neurological symptoms.
Treatment is supportive only.
Correct hyponatremia at a rate not in excess of 10mmol/L/24hr; diligently avoid hypernatremia. Details concerning the etiology and correction of electrolyte disorders are discussed extensively in general medicine texts. Alcoholic patients should receive vitamin supplementation. Formally evaluate their nutritional status. [7][8]
 Central pontine myelinolysis, MRI FLAIR |
 T2 weighted magnetic resonance scan image showing bilaterally symmetrical hyperintensities in Caudate nucleus (small, thin arrow), Putamen (long arrow), with sparing of Globus Pallidus (broad arrow), suggestive of Extrapontine myelinolysis. |
   | MedPix - osmotic myelinolysis images, MedPix® Medical Image Database and Teaching File Atlas |
| | Early diagnosis of central pontine myelinolysis with diffusion-weighted imaging - Early Diagnosis of Central Pontine Myelinolysis with Diffusion-Weighted Imaging -- Ruzek et al. 25 (2): 210 -- American Journal of Neuroradiology |
| | Outcome of central pontine and extrapontine myelinolysis (n = 44) - SpringerLink Home - Main |
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