Central pontine myelinolysis history and symptoms: Difference between revisions
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{{CMG}}; {{AE}} {{MMJ}} | {{CMG}}; {{AE}} {{MMJ}} | ||
==Overview== | ==Overview== | ||
< | Patients with central pontine myelinolysis may have a positive history of: [[Malnutrition]], [[Alcohol abuse|alcohol use disorder]], [[chronic liver disease]], [[hyperemesis gravidarum]], [[hypophosphatemia]] secondary to [[refeeding syndrome]] and prolonged [[Ischemia|ischemia.]] These patients with central pontine myelinolysis most commonly have a history of rapid [[sodium]] correction, greater than 0.5-1.0 mEq/L per hour. The most susceptible patients are those with: Chronic [[hyponatremia]] (>48 hours), severe [[hyponatremia]] (Na <120 mEq/L) and both chronic [[hyponatremia]] and severe [[hyponatremia]]. Common symptoms of central pontine myelinolysis include: Spastic [[quadriparesis]], [[dysarthria]], [[pseudobulbar palsy]] and [[altered mental status]]. In some patients, parkinsonian features, behavioral manifestations, and [[neuropsychological]] symptoms can also be present: [[Personality changes]], [[labile affect]], [[disinhibition]], poor judgment, [[Delusional disorder|paranoid delusions]], [[emotional lability]], [[delirium]], [[hallucinations]] and [[catatonia]]. | ||
==History and Symptoms== | ==History and Symptoms== | ||
===History=== | ===History=== | ||
| Line 22: | Line 22: | ||
*Severe [[hyponatremia]] (Na <120 mEq/L) | *Severe [[hyponatremia]] (Na <120 mEq/L) | ||
*Both | *Both chronic [[hyponatremia]] and severe [[hyponatremia]] | ||
===Common Symptoms=== | ===Common Symptoms=== | ||
Common symptoms of | Common symptoms of central pontine myelinolysis include:<ref name="pmid31869161">{{cite journal| author=| title=StatPearls | journal= | year= 2019 | volume= | issue= | pages= | pmid=31869161 | doi= | pmc= | url= }} </ref><ref name="pmid29295827">{{cite journal| author=Seliger S, Kestenbaum B| title=Commentary on Treatment of Severe Hyponatremia. | journal=Clin J Am Soc Nephrol | year= 2018 | volume= 13 | issue= 4 | pages= 650-651 | pmid=29295827 | doi=10.2215/CJN.13381217 | pmc=5969468 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29295827 }} </ref><ref name="pmid15300900">{{cite journal| author=Yu J, Zheng SS, Liang TB, Shen Y, Wang WL, Ke QH| title=Possible causes of central pontine myelinolysis after liver transplantation. | journal=World J Gastroenterol | year= 2004 | volume= 10 | issue= 17 | pages= 2540-3 | pmid=15300900 | doi=10.3748/wjg.v10.i17.2540 | pmc=4572157 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15300900 }} </ref><ref name="pmid28392953" /> | ||
*Spastic [[quadriparesis]] | *Spastic [[quadriparesis]] | ||
*[[Dysarthria]] | *[[Dysarthria]] | ||
| Line 31: | Line 32: | ||
*[[Altered mental status]] | *[[Altered mental status]] | ||
In some patients, parkinsonian features, behavioral manifestations, and [[neuropsychological]] symptoms can also be present:<ref name="pmid28392953">{{cite journal| author=Gopal M, Parasram M, Patel H, Ilorah C, Nersesyan H| title=Acute Psychosis as Main Manifestation of Central Pontine Myelinolysis. | journal=Case Rep Neurol Med | year= 2017 | volume= 2017 | issue= | pages= 1471096 | pmid=28392953 | doi=10.1155/2017/1471096 | pmc=5368399 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28392953 }} </ref><ref name="pmid19444382">{{cite journal| author=Post B, van Gool WA, Tijssen MA| title=Transient Parkinsonism in isolated extrapontine myelinolysis. | journal=Neurol Sci | year= 2009 | volume= 30 | issue= 4 | pages= 325-8 | pmid=19444382 | doi=10.1007/s10072-009-0088-9 | pmc=2707857 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19444382 }} </ref> | |||
*[[Personality changes]] | |||
*[[Labile affect]] | |||
*[[Disinhibition]] | |||
* Poor judgment | |||
*[[Delusional disorder|Paranoid delusions]] | |||
*[[Emotional lability]] | |||
*[[Delirium]] | |||
*[[Hallucinations]] | |||
*[[Catatonia]] | |||
==References== | ==References== | ||
Latest revision as of 18:16, 2 April 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
Patients with central pontine myelinolysis may have a positive history of: Malnutrition, alcohol use disorder, chronic liver disease, hyperemesis gravidarum, hypophosphatemia secondary to refeeding syndrome and prolonged ischemia. These patients with central pontine myelinolysis most commonly have a history of rapid sodium correction, greater than 0.5-1.0 mEq/L per hour. The most susceptible patients are those with: Chronic hyponatremia (>48 hours), severe hyponatremia (Na <120 mEq/L) and both chronic hyponatremia and severe hyponatremia. Common symptoms of central pontine myelinolysis include: Spastic quadriparesis, dysarthria, pseudobulbar palsy and altered mental status. In some patients, parkinsonian features, behavioral manifestations, and neuropsychological symptoms can also be present: Personality changes, labile affect, disinhibition, poor judgment, paranoid delusions, emotional lability, delirium, hallucinations and catatonia.
History and Symptoms
History
Patients with central pontine myelinolysis may have a positive history of:[1][2][3]
- Malnutrition
- Alcohol use disorder
- Chronic liver disease
- Hyperemesis gravidarum
- Hypophosphatemia secondary to refeeding syndrome
- Prolonged ischemia
These patients with central pontine myelinolysis most commonly have a history of rapid sodium correction, greater than 0.5-1.0 mEq/L per hour.
The most susceptible patients are those with:[1]
- Chronic hyponatremia (>48 hours)
- Severe hyponatremia (Na <120 mEq/L)
- Both chronic hyponatremia and severe hyponatremia
Common Symptoms
Common symptoms of central pontine myelinolysis include:[1][2][3][4]
In some patients, parkinsonian features, behavioral manifestations, and neuropsychological symptoms can also be present:[4][5]
- Personality changes
- Labile affect
- Disinhibition
- Poor judgment
- Paranoid delusions
- Emotional lability
- Delirium
- Hallucinations
- Catatonia
References
- ↑ 1.0 1.1 1.2 "StatPearls". 2019. PMID 31869161.
- ↑ 2.0 2.1 Seliger S, Kestenbaum B (2018). "Commentary on Treatment of Severe Hyponatremia". Clin J Am Soc Nephrol. 13 (4): 650–651. doi:10.2215/CJN.13381217. PMC 5969468. PMID 29295827.
- ↑ 3.0 3.1 Yu J, Zheng SS, Liang TB, Shen Y, Wang WL, Ke QH (2004). "Possible causes of central pontine myelinolysis after liver transplantation". World J Gastroenterol. 10 (17): 2540–3. doi:10.3748/wjg.v10.i17.2540. PMC 4572157. PMID 15300900.
- ↑ 4.0 4.1 Gopal M, Parasram M, Patel H, Ilorah C, Nersesyan H (2017). "Acute Psychosis as Main Manifestation of Central Pontine Myelinolysis". Case Rep Neurol Med. 2017: 1471096. doi:10.1155/2017/1471096. PMC 5368399. PMID 28392953.
- ↑ Post B, van Gool WA, Tijssen MA (2009). "Transient Parkinsonism in isolated extrapontine myelinolysis". Neurol Sci. 30 (4): 325–8. doi:10.1007/s10072-009-0088-9. PMC 2707857. PMID 19444382.