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Excerpt from Central Pontine MyelinolysisSynonyms, Key Words, and Related Terms: osmotic myelinolysis, CPM, hyponatremia, noninflammatory demyelination, stripping of the myelin sheath, alcoholism, liver disease, malnutrition Please click here to view the full topic text: Central Pontine MyelinolysisBackgroundAdams et al described central pontine myelinolysis (CPM) as a unique clinical entity. They published their findings in 1958, observing that patients who suffered from alcoholism or malnutrition developed spastic quadriplegia, pseudobulbar palsy, and varying degrees of encephalopathy or coma from acute, noninflammatory demyelination that centered within the basis pontis. Contemporary physicians recognize that CPM occurs inconsistently as a complication of severe and prolonged hyponatremia, particularly when corrected too rapidly. Standard of care requires judicious treatment of electrolyte disturbances to reduce the incidence of osmotic myelinolysis. PathophysiologyCPM is concentrated, frequently symmetric, noninflammatory demyelination within the central basis pontis. In at least 10% of patients with CPM, demyelination also occurs in extrapontine regions, including the mid brain, thalamus, basal nuclei, and cerebellum. The exact mechanism that strips the myelin sheath is unknown. One theory proposes that in regions of compact interdigitation of white and gray matter, cellular edema, which is caused by fluctuating osmotic forces, results in compression of fiber tracts and induces demyelination. Prolonged hyponatremia followed by rapid sodium correction results in edema. During the period of hyponatremia, the concentration of intracellular charged protein moieties is altered; reversal cannot parallel a rapid correction of electrolyte status. The term "osmotic myelinolysis" is more appropriate than "central pontine myelinolysis" for demyelination occurring in extrapontine regions after the correction of hyponatremia. FrequencyUnited StatesThe exact incidence of CPM is unknown. A study by Singh et al demonstrated that CPM was present in 29% of postmortem examinations of liver transplant patients. Two thirds of these patients had serum sodium fluctuations of only ± 15-20 mEq/L. Mortality/MorbidityRaceNo reports exist of CPM in African Americans. SexCPM occurs more frequently in females than in males. Please click here to view the full topic text: Central Pontine Myelinolysis |
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