The case has given us the opportunity of reflecting on cpm pathogenesis and management. Central pontine myelinolysis how is central pontine. Chronic alcoholism is frequently associated with this condition which may have. Central pontine myelinolysis symptoms, treatment and prognosis. Recovery after central pontine myelinolysis springerlink.
Recently hyponatremia and its rapid correction have been related to cpm. Central pontine myelinolysis genetic and rare diseases. Central pontine myelinolysis pathophysiology, causes. Central pontine myelinolysis cpm is a noninflammatory, demyelinating lesion usually localised in the basis pontis. The clinical features vary depending on the extent of involvement. Magnetic resonance mr features of a patient with profound hyponatremia and clinical findings of central pontine myelinolysis are presented. Some physicians have tried to treat myelinolysis with steroid medication or other experimental therapies, but none has been proven effective. Central pontine myelinolysis is a concentrated, frequently symmetric, noninflammatory demyelination within the central basis pontis.
Clinicians should maintain their vigilance while correcting electrolyte imbalances, especially with associated comorbidity. Split pdf files into individual pages, delete or rotate pages, easily merge pdf files together or edit and modify pdf files. Both the primary disturbance and its correction can result in lifethreatening neurological consequences. Central pontine myelinolysis cpm occurs in the setting of rapidly corrected hyponatremia, especially in chronically debilitated patients. Central pontine myelinolysis market research report.
As will be described below, almost all patients who develop ods present with a serum sodium concentration of 120 meql or less. Central pontine myelinolysis can be defined as a medical condition, in which the myelin sheath of the nerve cells in the brainstem become severely damaged. Demyelination can occur outside the pons as well and diagnosis can be challenging if both pontine and extrapontine areas are involved. Although the mechanism is not fully understood and the treatment is controversial, hyponatremia is probably considered to be the main pathophysiological basis. Sep 10, 2006 extrapontine myelinolysis presenting with extra pyramidal features suggestive of parkinsonism may be a challenging clinical syndrome. Feb 09, 2014 there may be no safe limit for the rate of rise of na. Pdf osmotic myelinolysis is an acute, rare, demyelinating process. A free and open source software to merge, split, rotate and extract pages from pdf files. Extrapontine myelinolysis presenting as acute parkinsonism. The cause of the disease has been primarily attributed to alcoholism. Extrapontine myelinolysis epm is one of the complications occurring secondary to rapid correction of hyponatremia, and is, along with central pontine myelinolysis encompassed by the more recent term osmotic demyelination syndrome. It is predominately iatrogenic treatmentinduced, and is characterized by acute paralysis, dysphagia difficulty swallowing, dysarthria difficulty speaking, and other neurological symptoms.
Does extrapontine myelinolysis precede central pontine myelinolysis. Classical clinical manifestations range from a depressed level of consciousness to dysarthria and flaccid quadriplegia. Combine pdfs in the order you want with the easiest pdf merger available. Parkinsonism and recovery in central and extrapontine.
It is the more recent term replacing central pontine myelinolysis, recognizing that extrapontine structures can also be affected, previously known as extrapontine myelinolysis. Parkinsonism and recovery in central and extrapontine myelinolysis ashok panagariya, rk sureka, dk udainiya department of neurology, sms medical college and hospital, jaipur, india. Correlation between ct and electrophysiologic data j. Pathogenesis and prevention of central pontine myelinolysis. Most published cases are based on autopsy reports, whereas antemortem diagnosis is rare. Central pontine and extrapontine myelinolysis owing to disequilibrium syndrome. Immediate mri of the brain was advised and requested to be. Intravenous immunoglobulin ivig in treatment of central pontine and extrapontine myelinolysis shahram izadyar, shumaila sultan, joseph s. Conventional ct and mr imaging findings lag the clinical manifestations of cpm. Pontine and extrapontine osmotic myelinolysis after the syndrome of inappropriate secretion of antidiuretic hormone siadh associated with fluoxetine case report. Central pontine myelinolysis cpm now termed osmotic demyelination syndrome ods, characterized by damage to regions of the brain most commonly pontine white matter tracts after rapid correction of metabolic disturbances such as hyponatremia low amounts of sodium in the blood.
Mar 23, 2020 there is no known cure for central pontine myelinolysis. Prognosis is not uniformly bad mri changes may be delayed mri severity is not prognostic r j martin central pontine and extrapontine myelinolysis. A 65 year old female known case of hypertension, first time detected type 2 diabetes mellitus was admitted in smhs hospital with history of altered sensorium for 1 day. Central pontine myelinolysis an overview sciencedirect topics. We present a case in which the diagnosis of cpm was confirmed by computed tomography ct. In at least 10% of patients with central pontine myelinolysis, demyelination also occurs in extrapontine regions, including the mid brain, thalamus, basal nuclei, and cerebellum. We describe an alcoholic patient who developed the disease. This simple webbased tool lets you merge pdf files in batches.
Central pontine myelinolysis cpm was described by adams et al in 1959 as a disease affecting alcoholics and the malnourished. Central pontine and extrapontine myelinolysis after alcohol. Thanks to the ninjadoc, i have been made aware of another way that a person can develop hyponatremia, which increases their risk for cpm. Central pontine myelinolysis and mri 71 volume, issue 1, january 2014 initial ct scan did not show any low attenuated areas. Pdf merge combinejoin pdf files online for free soda pdf. Learn what causes it and which symptoms to watch out for. Physical therapy may help maintain muscle strength, mobility, and function in weakened arms and legs. However, changes in sodium levels can lead to rapid movement of fluids in and out of the myelin sheath. Alcoholics, especially older ones, frequently experience enlargement of the ventricles as a result of atrophy of brain substance caused in part by the direct effects of alcohol on the central nervous system.
Informing others that chronic alcoholism is a major risk factor for central pontine myelinolysis would be of help. Goldsmith department of neurology, baylor college of medicine, houston, texas central pontine myelinolysis cpm extrapontine myelinolysis epm is usually associated with rapid. Alcoholism hyponatremia and central pontine myelinolysis. The population should be made aware of central pontine myelinolysis. Posts about alcoholism written by anti hyponatremia. Central pontine myelinolysis cpm is a rare condition characterised by spastic tetraparesis, pseudobulbar palsy and the lockedin syndrome. Combine different pdf documents or other files types like images and merge them into one pdf. Todd and i have corresponded for the past year, and i find his story also very motivational, so im happy to start sharing it here. This is a neurological disease, with a specific location area known as the pons and iatrogenic etiology. Extrapontine myelinolysis associated with pituitrin. We report a patient who developed cpm secondary to profound hyponatraemia and who recovered. Central pontine myelinolysis is mainly an iatrogenic disorder, and its appearance coincided with the widespread use of intravenous therapy for correction of fluid and electrolyte disorders. Central pontine myelinolysis information page national.
Pdf central pontine and extrapontine myelinolysis owing. Udainiya department of neurology, sms medical college and hospital, jaipur, india central pontine myelinolysis is a demyelinating affection of central pons diagnosed on the basis of characteristic mri finding in an appropriate clinical setting. Isolated extrapontine myelinolysis of osmotic demyelination syndrome. Myelinolysis, central pontine definition of myelinolysis.
Central pontine myelinolysis cpm, a neurologic disorder caused most frequently by rapid correction of hyponatremia, is characterized by demyelination that affects the central portion of the base of the pons. Extrapontine myelinolysis of osmotic demyelination syndrome. This online pdf merger allows you to quickly combine multiple pdf files into one pdf document for free. Central pontine myelinolysis is a demyelinating disorder characterized by the loss of myelin in the center of the basis pontis usually caused by rapid correction of chronic hyponatremia. Hyponatremia is the most common electrolyte abnormality encountered in hospitalized patients, resulting from a varied spectrum of conditions. Central pontine myelinolysis how is central pontine myelinolysis abbreviated. Resolution of the mr findings paralleled the clinical recovery. If you are looking for a way to combine two or more pdfs into a single file, try pdfchef for free. Osmotic demyelination syndrome radiology reference article. Pdf pontine and extrapontine osmotic myelinolysis after. Jul 21, 2011 central pontine myelinolysis cpm is a neurological disorder that most frequently occurs when sodium deficiency is treated too rapidly. Our pdf merger allows you to quickly combine multiple pdf files into one single pdf document, in just a few clicks.
It is not clearly known how the myelin sheath damage occurs. Intravenous immunoglobulin ivig in treatment of central. Individuals are likely to require extensive and prolonged physical therapy and rehabilitation. Soda pdf merge tool allows you to combine two or more documents into a single pdf file for free.
We would like to present a case of isolated extrapontine myelinolysis of the osmotic demyelination syndrome which has been reported only a few times in the literature. Central pontine myelinolysis cpm is a neurological disorder that most frequently occurs after too rapid medical correction of sodium deficiency hyponatremia. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. The disequilibrium syndrome can be seen, usually soon after or toward the end of dialysis. Central pontine and extrapontine myelinolysis after. The osmotic demyelination syndrome j neurol neurosurg psychiatry 2004. In 1976 a link between these disorders and the rapid correction of sodium in hyponatraemic patients was suggested, and. Central pontine myelinolysis cpm is known to be almost universally fatal. Diabetic ketoacidosis, alcoholic ketoacidosis, starvation ketosis and hypoglycaemic ketoacidosis. Parkinsonism and recovery in central and extrapontine myelinolysis a.
The extrapontine myelinolysis of osmotic demyelination syndrome ods is a wellknown but uncommon disorder of the central nervous system. Extrapontine myelinolysis is one such complication that is associated with the rapid correction of hyponatremia. The part of the brain called the pons is especially sensitive and too much sodium can damage nerve fibers. On rare occasions, demyelination occurs outside the pons and is termed extrapontine myelinolysis epm.
Early diagnosis of central pontine myelinolysis with. There are no inflammatory changes, and blood vessels are normal. Osmotic demyelination syndrome refers to acute demyelination seen in the setting of osmotic changes, typically with the rapid correction of hyponatremia. Central pontine myelinolysis cpm is a noninflammatory, demyelinating condition that has been described mostly in the context of rapid correction of hyponatraemia. Central pontine myelinolysis cpm was described by adams and colleagues in 1959 as a disease affecting alcoholics and the malnourished adams et al. A 41yearold woman presented with acute parkinsonism like features while on a holiday. Prevention can be attained when people know the existence of such fatal disease, thus decreasing its incidence rate. Central pontine myelinolysis with clinical recovery. Central pontine myelinolysis, or cpm, is a neurological disorder that affects the brain. There are few reports of ods caused by a sellar lesion. Central pontine myelinolysis cpm is a neurological condition involving severe damage to the myelin sheath of nerve cells in the pons an area of the brainstem.
Neurologic disorders can be seen in patients with endstage renal failure owing to complications of hemodialysis or peritoneal dialysis. We present a case in which restricted diffusion was identified within the central pons by using mr diffusionweighted imaging within 24 hours of onset of patient. Pdf central pontine myelinolysis cpm was described by adams and colleagues in 1959 as a disease affecting alcoholics and the malnourished. Extrapontine myelinolysis radiology reference article. Central pontine myelinolysis cpm is a demyelinating disease producing serious or even fatal illness. The neurologic manifestations associated with overly rapid correction have been called the osmotic demyelination syndrome ods. This free online tool allows to combine multiple pdf or image files into a single pdf document. Market synopsis of global central pontine myelinolysis market, market scenario, central pontine myelinolysis cpm, also known as osmotic demyelination syndrome or central pontine demyelination, is a neurological disorder caused by severe damage of the myelin sheath of neurons. Early detection of central pontine myelinolysis with mri. Khan 1, 2, department of physiology and biophysics, suny at stony brook, new york 11794, usa. Extrapontine myelinolysis epm is one of the complications occurring secondary to rapid correction of hyponatremia, and is, along with central pontine myelinolysis encompassed by the more recent term osmotic demyelination syndrome in the vast majority of cases it is associated with central pontine myelinolysis but it can also rarely occur as an isolated entity. The condition commonly results from a rapid increase in the sodium levels of the human body.