Central pontine myelinolysis

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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

Causes

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]

Non-alcoholic patients can be affected; these include: -underlying severe liver disease -liver transplant patients -severe burns -malnutrition -anorexia -severe electrolyte disorders -AIDS

It can be associated with Hyperemesis gravidarum.

Diagnosis

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.

Symptoms

Frequently observed symptoms in this disorder are acute para- or quadraparesis, dysphagia, dysarthria, diplopia, loss of consciousness, and other neurological symptoms associated with brainstem damage. The patient may experience locked-in syndrome where cognitive function is intact, but all muscles are paralyzed with the exception of eye blinking. These result from a rapid myelinolysis of the corticobulbar and corticospinal tracts in the brainstem.

Treatment and Prevention

Treatment is supportive only.

To prevent CPM via the most common cause, overly rapid correction of hyponatremia, the hyponatremia should be corrected at a rate not in excess of 10mmol/L/24hr or 0.5 mEq/L/Hr; thus diligently avoiding hypernatremia. Details concerning the etiology and correction of electrolyte disorders are discussed extensively in general medicine texts. Alcoholic patients should receive vitamin supplementation and a formal evaluation of their nutritional status. [7][8]

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