Central pontine myelinolysis
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| Central pontine myelinolysis | |
 | |
|---|---|
| Pons labeled at bottom left | |
| ICD-10 | G37.2 |
| DiseasesDB | 2198 |
| MedlinePlus | 000775 |
| MeSH | D017590 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: CPM; osmotic demyelination syndrome; osmotic myelinolysis; central pontine myelinosis
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. Central pontine myelinosis is a demyelinating lesion in 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.
Causes
The most common cause is the rapid correction of low blood sodium levels (hyponatremia).
Risk Factors
It has been postulated that the real cause might 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
Symptoms
- Sudden para or quadraparesis, dysphagia, dysarthria, double vision and loss of consciousness.
- Confusion, delirium
- Balance problems
- Difficulty swallowing
- Hallucinations
- Reduced alertness, drowsiness or sleepiness, lethargy, poor responses
- Speech changes, poor enunciation
- Tremor
- Weakness in the face, arms, or legs, usually affecting both sides of the body
- Locked-in syndrome where cognitive function is intact, but all muscles are paralyzed with the exception of eye blinking
MRI
Imaging by MRI demonstrates an area of high signal return on T2 weighted images.
Treatment
To avoid myelinolysis, the correction of hyponatremia should not exceed 1 mEq/L per hour. [2][3]
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
- ↑ Kleinschmidt-DeMasters BK, Norenberg MD. Rapid correction of hyponatremia causes demyelination: relation to central pontine myelinolysis. Science. 1981;211(4486):1068-70. PMID 7466381
- ↑ Laureno R. Experimental pontine and extrapontine myelinolysis. Trans Am Neurol Assoc. 1980;105:354-8. PMID 7348981
Template:Diseases of the nervous system de:Zentrale pontine Myelinolyse