Central pontine myelinolysis differential diagnosis
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Central pontine myelinolysis Microchapters |
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Differentiating Central pontine myelinolysis from other Diseases |
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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
On the basis central pontine myelinolysis must be differentiated diseases that cause acute confusion, lethargy, speech difficulties and bilateral weakness or quadriplegia such as: Posterior leukoencephalopathy syndrome, infective encephalitis, ischemic Brain stem infarction, thalamus infarction due thrombosis of the basilar artery, diffuse hypoxic encephalopathy, metastasis to the brain and brain tumors such as glioma.
Differentiating central pontine myelinolysis from other Diseases
On the basis central pontine myelinolysis must be differentiated diseases that cause acute confusion, lethargy, speech difficulties and bilateral weakness or quadriplegia such as:[1][2][3][4][5][6]
- Posterior leukoencephalopathy syndrome
- Hypertensive encephalopathy
- Infective encephalitis
- Ischemic Brain stem infarction
- Thalamus infarction due thrombosis of the basilar artery
- Diffuse hypoxic encephalopathy
- Metastasis to the brain
- Brain tumors such as glioma
Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]
On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].
| Diseases | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | |||
|---|---|---|---|---|---|---|---|
| Lab Findings | Imaging | ||||||
| Confusion | Weakness and quadriplegia | Speech difficulties | Hypoosmotic hyponatremia | MRI | |||
| Central pontine myelinolysis | ++ | ++ | ++ | ++ |
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MRI | The most common cause of central pontine myelinolysis is rapid correction(>48-hours duration) of hyponatremia in patients with the history of prolonged hyponatremia |
| Posterior leukoencephalopathy syndrome | ++ | -/+ | -/+ | - | Multiple cortico-subcortical areas of T2-weighted hyperintense signal involving the occipital and parietal lobes bilaterally and pons. | MRI | Other symptoms include: Seizure, headache, visual disturbances, focal neurologic signs, and status epilepticus.
Many cases resolve within 1–2 weeks of controlling blood pressure and eliminating the inciting factor. |
| Hypertensive encephalopathy | -/+ | -/+ | + | - |
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MRI | Symptoms typically start to occur 12–48 hours after a sudden and sustained increase in blood pressure.
The first symptom is a severe headache. Other symptoms include: Impaired judgement and memory |
| Infective encephalitis | -/+ | -/+ | -/+ | - |
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MRI | |
| Differential Diagnosis 5 | |||||||
| Differential Diagnosis 6 | |||||||
References
- ↑ Kawabori M, Murata J, Abe S, Saito H (2009). "[A case of brainstem variant of reversible posterior leukoencephalopathy syndrome]". No Shinkei Geka. 37 (11): 1105–9. PMID 19938667.
- ↑ Osman Y, Imam YZ, Salem K, Al-Hail H, Uthman B, Deleu D (2013). "Isolated brainstem involvement in a patient with hypertensive encephalopathy". Case Rep Neurol Med. 2013: 540947. doi:10.1155/2013/540947. PMC 3600275. PMID 23533856.
- ↑ Uchino A, Sawada A, Takase Y, Kudo S (2004). "Symmetrical lesions of the middle cerebellar peduncle: MR imaging and differential diagnosis". Magn Reson Med Sci. 3 (3): 133–40. doi:10.2463/mrms.3.133. PMID 16093630.
- ↑ Uzkeser M, Akoz A, Ozdemir G, Emet M, Bayramoglu A (2012). "Wide central pontine, bulbar and thalamic myelinolysis with sequela". Eurasian J Med. 44 (3): 179–81. doi:10.5152/eajm.2012.42. PMC 4261386. PMID 25610237.
- ↑ Choi JM, Kim YH, Roh SY (2013). "Acute hepatic encephalopathy presenting as cortical laminar necrosis: case report". Korean J Radiol. 14 (2): 324–8. doi:10.3348/kjr.2013.14.2.324. PMC 3590348. PMID 23482893.
- ↑ Quattrocchi CC, Errante Y, Rossi Espagnet MC, Galassi S, Della Sala SW, Bernardi B; et al. (2016). "Magnetic resonance imaging differential diagnosis of brainstem lesions in children". World J Radiol. 8 (1): 1–20. doi:10.4329/wjr.v8.i1.1. PMC 4731345. PMID 26834941.