Central pontine myelinolysis overview
|
Central pontine myelinolysis Microchapters |
|
Differentiating Central pontine myelinolysis from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Central pontine myelinolysis overview On the Web |
|
American Roentgen Ray Society Images of Central pontine myelinolysis overview |
|
Risk calculators and risk factors for Central pontine myelinolysis overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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 is a complication of treatment of patients with profound, life threatening hyponatraemia. It occurs as a consequence of a rapid rise in serum tonicity following treatment in individuals with chronic severe hyponatraemia who have made intracellular adaptations to the prevailing hypotonicity. It can also occur as a complication of correcting hypernatremia too rapidly.
Pathophysiology
Rapid correction of hypernatremia causes water to move into cells, leading to multiple cerebral hemorrhages, equally catastrophic as osmotic demyelination.
Causes
The most common cause is the rapid correction of low blood sodium levels (hyponatremia). Over rapid correction of high levels of salt in the blood (hypernatremia) can also cause the condition.
Risk Factors
It has been postulated that one underlying cause may be the lack of a substance that is essential for brain activity and is lacking due to malnutrition. The fact that this condition is most frequently observed in patients with general ill health (alcoholism, cachexia etc.) is in accordance with this hypothesis. [1]
Diagnosis
MRI
Imaging by MRI demonstrates an area of high signal return on T2 weighted images.
Treatment
Prevention
Gradual, controlled treatment of low sodium levels may reduce the risk of nerve damage in the pons. Being aware of how some medications can change sodium levels can prevent these levels from changing too quickly.
References
- ↑ Adams RA, Victor M, Mancall EL. Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholics and malnourished patients. Arch Neurol Psychiatry. 1959;81:154–72. PMID 13616772