Central pontine myelinolysis

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. The term "osmotic demyelinization syndrome" is similar to "central pontine myelinolysis", but also includes areas outside the pons.

Causes
The most common cause is the rapid correction of low blood sodium levels (hyponatremia).

It has been observed following hematopoietic stem cell transplantation.

It is frequently associated with alcoholism.

Diagnosis
It can be difficult to identify using conventional imaging techniques.

Imaging by MRI demonstrates an area of high signal return on T2 weighted images.

Symptoms
Frequently observed symptoms in this disorder are sudden para or quadraparesis, dysphagia, dysarthria, diplopia and loss of consciousness. The patient may experience locked-in syndrome where cognitive function is intact, but all muscles are paralyzed with the exception of eye blinking.

Treatment
Treatment is supportive only.

Correct hyponatremia at a rate of 10 µmol/L/24 h; diligently avoid hypernatremia. Details concerning the etiology and correction of electrolyte disorders are discussed extensively in general medicine texts. Alcoholic patients should receive vitamin supplementation. Formally evaluate their nutritional status.