Central pontine myelinolysis

Presentation

Sudden onset of mental confusion and seizures during his admission due a adynamic ileus.

Patient Data

Age: 35
Gender: Male
MRI

A symmetric and well-delimited lesion is seen located at the central portion of the pons with high signal on T2 weighted images and low signal on T1 images. This lesion spares the peripheral fibers.

Case Discussion

Central pontine myelinolysis (CPM) was first termed in 1959 by Adams to describe a symmetric, demyelinating focus prominent in the central pons.The original patient population included only chronic alcoholics.This condition, however, has also been found in the malnourished, transplant recipients, or chronically debilitated patients,in particular, those in whom electrolyte abnormalities include hyponatremia that is rapidly over-corrected. 

Symptoms of CPM include tetraplegia, pseudobulbar palsy, and acute changes in mental status leading to coma or death without intervention. Similar histologic symmetric lesions were later identified in extrapontine locations, including the white matter of the cerebellum, thalamus, globus pallidus, putamen, and lateral geniculate body, a condition termed extrapontine myelinolysis

Today, the term osmotic demyelination syndrome is preferred to reflect both pontine and extrapontine involvement. 

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