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{{Central pontine myelinolysis}}
{{Central pontine myelinolysis}}
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{{CMG}}; {{AE}} {{MMJ}}
==Overview==
==Overview==
Patients with central pontine myelinolysis may have a positive history of: [[Malnutrition]], [[Alcohol abuse|alcohol use disorder]], [[chronic liver disease]], [[hyperemesis gravidarum]], [[hypophosphatemia]] secondary to [[refeeding syndrome]] and prolonged [[Ischemia|ischemia.]] These patients with central pontine myelinolysis most commonly have a history of rapid [[sodium]] correction, greater than 0.5-1.0 mEq/L per hour. The most susceptible patients are those with: Chronic [[hyponatremia]] (>48 hours), severe [[hyponatremia]] (Na <120 mEq/L) and both chronic [[hyponatremia]] and severe [[hyponatremia]]. Common symptoms of central pontine myelinolysis include: Spastic [[quadriparesis]], [[dysarthria]], [[pseudobulbar palsy]] and [[altered mental status]]. In some patients, parkinsonian features, behavioral manifestations, and [[neuropsychological]] symptoms can also be present: [[Personality changes]], [[labile affect]], [[disinhibition]], poor judgment, [[Delusional disorder|paranoid delusions]], [[emotional lability]], [[delirium]], [[hallucinations]] and [[catatonia]].
==History and Symptoms==
==History and Symptoms==
*Sudden para or [[quadraparesis]], [[dysphagia]], [[dysarthria]], [[double vision]] and [[coma|loss of consciousness]].
===History===
*[[Confusion (patient information)|Confusion]], [[Delirium (patient information)|delirium]]
Patients with central pontine myelinolysis may have a positive history of:<ref name="pmid31869161">{{cite journal| author=| title=StatPearls | journal= | year= 2019 | volume=  | issue=  | pages=  | pmid=31869161 | doi= | pmc= | url= }} </ref><ref name="pmid29295827">{{cite journal| author=Seliger S, Kestenbaum B| title=Commentary on Treatment of Severe Hyponatremia. | journal=Clin J Am Soc Nephrol | year= 2018 | volume= 13 | issue= 4 | pages= 650-651 | pmid=29295827 | doi=10.2215/CJN.13381217 | pmc=5969468 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29295827  }} </ref><ref name="pmid15300900">{{cite journal| author=Yu J, Zheng SS, Liang TB, Shen Y, Wang WL, Ke QH| title=Possible causes of central pontine myelinolysis after liver transplantation. | journal=World J Gastroenterol | year= 2004 | volume= 10 | issue= 17 | pages= 2540-3 | pmid=15300900 | doi=10.3748/wjg.v10.i17.2540 | pmc=4572157 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15300900  }} </ref>
*[[Balance problems]]
*[[Malnutrition]]
*[[Difficulty swallowing]]
*[[Alcohol abuse|Alcohol use disorder]]
*[[Hallucination (patient information)|Hallucinations]]
*[[Chronic liver disease]]
*[[Reduced alertness]], [[Drowsiness (patient information)|drowsiness]] or [[sleepiness]], [[lethargy]], poor responses
*[[Hyperemesis gravidarum]]
*Speech changes, poor enunciation
* [[Hypophosphatemia]] secondary to [[refeeding syndrome]]
*[[Tremor]]
* Prolonged [[ischemia]]
*[[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
These patients with central pontine myelinolysis most commonly have a history of rapid [[sodium]] correction, greater than 0.5-1.0 mEq/L per hour.
 
The most susceptible patients are those with:<ref name="pmid31869161">{{cite journal| author=| title=StatPearls | journal= | year= 2019 | volume=  | issue=  | pages=  | pmid=31869161 | doi= | pmc= | url= }} </ref>
 
*Chronic [[hyponatremia]] (>48 hours)
 
*Severe [[hyponatremia]] (Na <120 mEq/L)
*Both chronic [[hyponatremia]] and severe [[hyponatremia]]
 
===Common Symptoms===
Common symptoms of central pontine myelinolysis include:<ref name="pmid31869161">{{cite journal| author=| title=StatPearls | journal= | year= 2019 | volume=  | issue=  | pages=  | pmid=31869161 | doi= | pmc= | url= }} </ref><ref name="pmid29295827">{{cite journal| author=Seliger S, Kestenbaum B| title=Commentary on Treatment of Severe Hyponatremia. | journal=Clin J Am Soc Nephrol | year= 2018 | volume= 13 | issue= 4 | pages= 650-651 | pmid=29295827 | doi=10.2215/CJN.13381217 | pmc=5969468 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29295827  }} </ref><ref name="pmid15300900">{{cite journal| author=Yu J, Zheng SS, Liang TB, Shen Y, Wang WL, Ke QH| title=Possible causes of central pontine myelinolysis after liver transplantation. | journal=World J Gastroenterol | year= 2004 | volume= 10 | issue= 17 | pages= 2540-3 | pmid=15300900 | doi=10.3748/wjg.v10.i17.2540 | pmc=4572157 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15300900  }} </ref><ref name="pmid28392953" />
 
*Spastic [[quadriparesis]]
*[[Dysarthria]]
*[[Pseudobulbar palsy]]
*[[Altered mental status]]
 
In some patients, parkinsonian features, behavioral manifestations, and [[neuropsychological]] symptoms can also be present:<ref name="pmid28392953">{{cite journal| author=Gopal M, Parasram M, Patel H, Ilorah C, Nersesyan H| title=Acute Psychosis as Main Manifestation of Central Pontine Myelinolysis. | journal=Case Rep Neurol Med | year= 2017 | volume= 2017 | issue=  | pages= 1471096 | pmid=28392953 | doi=10.1155/2017/1471096 | pmc=5368399 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28392953  }} </ref>
 
*[[Personality changes]]
*[[Labile affect]]
*[[Disinhibition]]
* Poor judgment
*[[Delusional disorder|Paranoid delusions]]
*[[Emotional lability]]
*[[Delirium]]
*[[Hallucinations]]
*[[Catatonia]]
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Revision as of 18:19, 30 December 2019

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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

Patients with central pontine myelinolysis may have a positive history of: Malnutrition, alcohol use disorder, chronic liver disease, hyperemesis gravidarum, hypophosphatemia secondary to refeeding syndrome and prolonged ischemia. These patients with central pontine myelinolysis most commonly have a history of rapid sodium correction, greater than 0.5-1.0 mEq/L per hour. The most susceptible patients are those with: Chronic hyponatremia (>48 hours), severe hyponatremia (Na <120 mEq/L) and both chronic hyponatremia and severe hyponatremia. Common symptoms of central pontine myelinolysis include: Spastic quadriparesis, dysarthria, pseudobulbar palsy and altered mental status. In some patients, parkinsonian features, behavioral manifestations, and neuropsychological symptoms can also be present: Personality changes, labile affect, disinhibition, poor judgment, paranoid delusions, emotional lability, delirium, hallucinations and catatonia.

History and Symptoms

History

Patients with central pontine myelinolysis may have a positive history of:[1][2][3]

These patients with central pontine myelinolysis most commonly have a history of rapid sodium correction, greater than 0.5-1.0 mEq/L per hour.

The most susceptible patients are those with:[1]

Common Symptoms

Common symptoms of central pontine myelinolysis include:[1][2][3][4]

In some patients, parkinsonian features, behavioral manifestations, and neuropsychological symptoms can also be present:[4]

References

  1. ↑ 1.0 1.1 1.2 "StatPearls". 2019. PMID 31869161.
  2. ↑ 2.0 2.1 Seliger S, Kestenbaum B (2018). "Commentary on Treatment of Severe Hyponatremia". Clin J Am Soc Nephrol. 13 (4): 650–651. doi:10.2215/CJN.13381217. PMC 5969468. PMID 29295827.
  3. ↑ 3.0 3.1 Yu J, Zheng SS, Liang TB, Shen Y, Wang WL, Ke QH (2004). "Possible causes of central pontine myelinolysis after liver transplantation". World J Gastroenterol. 10 (17): 2540–3. doi:10.3748/wjg.v10.i17.2540. PMC 4572157. PMID 15300900.
  4. ↑ 4.0 4.1 Gopal M, Parasram M, Patel H, Ilorah C, Nersesyan H (2017). "Acute Psychosis as Main Manifestation of Central Pontine Myelinolysis". Case Rep Neurol Med. 2017: 1471096. doi:10.1155/2017/1471096. PMC 5368399. PMID 28392953.

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