Central pontine myelinolysis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 18: Line 18:
{{SK}} CPM; osmotic demyelination syndrome; osmotic myelinolysis; central pontine myelinosis
{{SK}} CPM; osmotic demyelination syndrome; osmotic myelinolysis; central pontine myelinosis


==Overview==
==[[Central pontine myelinolysis overview|Overview]]==
'''Central pontine myelinolysis''' is a neurologic disease caused by severe damage of the [[myelin sheath]] of [[neuron|nerve cells]] in the [[brainstem]], more precisely in the area termed 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. It can also occur as a complication of correcting [[hypernatremia]] too rapidly.


==Pathophysiology==
==[[Central pontine myelinolysis historical perspective|Historical Perspective]]==
Brain cells adjust their osmolarities by changing levels of certain [[osmolytes]] like [[Inositol]], [[Betaine]], and [[Glutamine]]. In [[hyponatremia]] the levels of these osmolytes fall, preventing entry of free-water into cells. The reverse is true for [[hypernatremia]]. So rapid correction of [[sodium]] in [[hyponatremia]] would cause the extra cellular fluid to be relatively hypertonic. Free-water would then move out of the cells. This leads to central pontine myelinolysis.  Rapid correction of [[hypernatremia]] causes water to move into cells, leading to multiple cerebral hemorrhages, equally catastrophic as osmotic demyelination.


==Causes==
==[[Central pontine myelinolysis pathophysiology|Pathophysiology]]==
The most common cause is the rapid correction of low blood sodium levels ([[hyponatremia]]). Over rapid correction of high levels of salt in the blood ([[hypernatremia]]) can also cause the condition.


==Risk Factors==
==[[Central pontine myelinolysis causes|Causes]]==
It has been postulated that one underlying cause may 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. <ref>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</ref>


==Natural History, Complications, Prognosis==
==[[Central pontine myelinolysis differential diagnosis|Differentiating Central pontine myelinolysis from other Diseases]]==
The nerve damage caused by central pontine myelinolysis is usually long-lasting, and the disorder can cause serious long-term (chronic) disability.


===Complications===
==[[Central pontine myelinolysis epidemiology and demographics|Epidemiology and Demographics]]==
*Decreased ability to interact with others
*Decreased ability to work or care for self
*Inability to move, other than to blink eyes ([["locked in" syndrome]])
*Permanent nervous system damage


==Diagnosis==
==[[Central pontine myelinolysis risk factors|Risk Factors]]==


===Symptoms===
==[[Central pontine myelinolysis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
*Sudden para or [[quadraparesis]], [[dysphagia]], [[dysarthria]], [[double vision]] and [[coma|loss of consciousness]].
*[[Confusion (patient information)|Confusion]], [[Delirium (patient information)|delirium]]
*[[Balance problems]]
*[[Difficulty swallowing]]
*[[Hallucination (patient information)|Hallucinations]]
*[[Reduced alertness]], [[Drowsiness (patient information)|drowsiness]] or [[sleepiness]], [[lethargy]], poor responses
*Speech changes, poor enunciation
*[[Tremor]]
*[[Muscle weakness (patient information)|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 [[Magnetic resonance imaging|MRI]] demonstrates an area of high signal return on T2 weighted images.


==Diagnosis==
[[Central pontine myelinolysis history and symptoms|History and Symptoms]] | [[Central pontine myelinolysis physical examination|Physical Examination]] | [[Central pontine myelinolysis laboratory findings|Laboratory Findings]] | [[Central pontine myelinolysis CT|CT]] | [[Central pontine myelinolysis MRI|MRI]] | [[Central pontine myelinolysis echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Central pontine myelinolysis other imaging findings|Other Imaging Findings]] | [[Central pontine myelinolysis other diagnostic studies|Other Diagnostic Studies]]
==Treatment==
==Treatment==
To avoid myelinolysis, the correction of hyponatremia should not exceed 1 mEq/L per hour. <ref>Kleinschmidt-DeMasters BK, Norenberg MD. Rapid correction of hyponatremia causes demyelination: relation to central pontine myelinolysis. ''Science.'' 1981;211(4486):1068-70. PMID 7466381</ref><ref>Laureno R. Experimental pontine and extrapontine myelinolysis. ''Trans Am Neurol Assoc.'' 1980;105:354-8. PMID 7348981</ref>  There is no specific treatment and the syndrome is associated with high mortality and morbidity. This being a potentially avoidable disaster, following recommendations may be adhered to while maintaining sodium levels:
[[Central pontine myelinolysis medical therapy|Medical Therapy]] | [[Central pontine myelinolysis prevention|Prevention]] | [[Central pontine myelinolysis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Central pontine myelinolysis future or investigational therapies|Future or Investigational Therapies]]
 
==Case Studies==
===Hyponatremia===
[[Central pontine myelinolysis case study one|Case #1]]
The rate of correction of [[hyponatremia]] should be 0.5-1.0meq/L/hr, with not more than a 12 meq/l correction in 24 hrs. If the patient has ongoing [[seizures]] (or [Na<sup>+</sup>]<115 meq/li), correction can be attempted at up to 2 meq/L/hr, but only while [[seizure activity]] lasts and the [Na<sup>+</sup>] exceeds 125-130 meq/Li.
 
===Hypernatremia===
The rate of correction of [[hypernatremia]] should be at 0.5meq/L/hr and should not exceed 12 meq/Li/24hrs.


== References ==
{{reflist|2}}


{{Diseases of the nervous system}}
{{Diseases of the nervous system}}

Revision as of 13:47, 28 September 2012

Central pontine myelinolysis
Pons labeled at bottom left
ICD-10 G37.2
DiseasesDB 2198
MedlinePlus 000775
MeSH D017590

For patient information, click here

Central pontine myelinolysis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Central pontine myelinolysis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Central pontine myelinolysis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Central pontine myelinolysis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Central pontine myelinolysis

CDC on Central pontine myelinolysis

Central pontine myelinolysis in the news

Blogs on Central pontine myelinolysis

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Central pontine myelinolysis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: CPM; osmotic demyelination syndrome; osmotic myelinolysis; central pontine myelinosis

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Central pontine myelinolysis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1


Template:Diseases of the nervous system de:Zentrale pontine Myelinolyse

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Central_pontine_myelinolysis&oldid=760218"