Difference between revisions of "Central pontine myelinolysis differential diagnosis"

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Revision as of 20:27, 24 February 2020

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Central pontine myelinolysis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

On the basis central pontine myelinolysis must be differentiated diseases that cause acute confusion, lethargy, speech difficulties and bilateral weakness or quadriplegia such as: Posterior leukoencephalopathy syndrome, infective encephalitis, ischemic Brain stem infarction, thalamus infarction due thrombosis of the basilar artery, diffuse hypoxic encephalopathy, metastasis to the brain and brain tumors such as glioma.

Differentiating central pontine myelinolysis from other Diseases

On the basis central pontine myelinolysis must be differentiated diseases that cause acute confusion, lethargy, speech difficulties and bilateral weakness or quadriplegia such as:[1][2][3][4][5][6][7]

Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Lab Findings Imaging
Confusion Weakness and quadriplegia Speech difficulties Hypoosmotic hyponatremia MRI
Central pontine myelinolysis ++ ++ ++ ++
  • Symmetric signal intensity abnormality in the central pons at T2-weighted and FLAIR imaging
  • Decreased T1 signal intensity
  • Fluid attenuated inversion recovery (FLAIR) hyperintense lesion in the pons
  • Intramedullary central T2 hyperintensity at axial T2W of spinal cord and sagittal T2W of thoracic spinal cord
MRI The most common cause of central pontine myelinolysis is rapid correction(>48-hours duration) of hyponatremia in patients with the history of prolonged hyponatremia
Posterior leukoencephalopathy syndrome ++ -/+ -/+ - Multiple cortico-subcortical areas of T2-weighted hyperintense signal involving the occipital and parietal lobes bilaterally and pons. MRI Other symptoms include: Seizure, headache, visual disturbances, focal neurologic signs, and status epilepticus.

Many cases resolve within 1–2 weeks of controlling blood pressure and eliminating the inciting factor.

Hypertensive encephalopathy -/+ -/+ + -
  • Diffuse extensive periventricular deep white matter T2 hyperintensity changes
  • Ex vacuo ventriculomegaly
  • Global, symmetrical, supra and infratentorial involutional changes
MRI Symptoms typically start to occur 12–48 hours after a sudden and sustained increase in blood pressure.

The first symptom is a severe headache.

Other symptoms include:

Impaired judgement and memory

Infective encephalitis -/+ -/+ -/+ -
  • High signal in both white and grey matter
  • Region of hypodensity
MRI


References

  1. Kawabori M, Murata J, Abe S, Saito H (2009). "[A case of brainstem variant of reversible posterior leukoencephalopathy syndrome]". No Shinkei Geka. 37 (11): 1105–9. PMID 19938667.
  2. Osman Y, Imam YZ, Salem K, Al-Hail H, Uthman B, Deleu D (2013). "Isolated brainstem involvement in a patient with hypertensive encephalopathy". Case Rep Neurol Med. 2013: 540947. doi:10.1155/2013/540947. PMC 3600275. PMID 23533856.
  3. Uchino A, Sawada A, Takase Y, Kudo S (2004). "Symmetrical lesions of the middle cerebellar peduncle: MR imaging and differential diagnosis". Magn Reson Med Sci. 3 (3): 133–40. doi:10.2463/mrms.3.133. PMID 16093630.
  4. Uzkeser M, Akoz A, Ozdemir G, Emet M, Bayramoglu A (2012). "Wide central pontine, bulbar and thalamic myelinolysis with sequela". Eurasian J Med. 44 (3): 179–81. doi:10.5152/eajm.2012.42. PMC 4261386. PMID 25610237.
  5. Choi JM, Kim YH, Roh SY (2013). "Acute hepatic encephalopathy presenting as cortical laminar necrosis: case report". Korean J Radiol. 14 (2): 324–8. doi:10.3348/kjr.2013.14.2.324. PMC 3590348. PMID 23482893.
  6. Quattrocchi CC, Errante Y, Rossi Espagnet MC, Galassi S, Della Sala SW, Bernardi B; et al. (2016). "Magnetic resonance imaging differential diagnosis of brainstem lesions in children". World J Radiol. 8 (1): 1–20. doi:10.4329/wjr.v8.i1.1. PMC 4731345. PMID 26834941.
  7. Shalchi Z, Bennett A, Hargroves D, Nash J (2009). "Diagnostic delay in a case of herpes simplex encephalitis". BMJ Case Rep. 2009. doi:10.1136/bcr.12.2008.1350. PMC 3028237. PMID 21686359.

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