Home >> Neurological Research, Volume 28, Number 3

Central pontine myelinolysis, an update

Authors: Kumar, Suresh1; Fowler, Marjorie2; Gonzalez-Toledo, Eduardo3; Jaffe, S. L.1

Source: Neurological Research, Volume 28, Number 3, April 2006 , pp. 360-366(7)

Publisher: Maney Publishing

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Abstract:

Central pontine myelinolysis (CPM) can be regarded as one of the demyelinating syndromes. First described by Adams et al. in 1959 in their chronic alcoholic patients, it has now been described in the malnourished, the chronically debilitated, the renal, the hepatic and the transplant patient among others. Pathologically, it is defined as a symmetric area of myelin disruption in the center of the basis pontis, although similar symmetric lesions have also been described occurring with CPM as well as independently in other brain areas (extrapontine myelinolysis or EPM) including the cerebellar and neocortical white/gray junctional areas, thalamus and striatum. Possible mechanisms include a hyperosmotically induced demyelination process resulting from rapid intracellular/ extracellular to intravascular water shifts producing relative glial dehydration and myelin degradation and/or oligodendroglial apoptosis. The process most often occurs during rapid rebalancing of the electrolyte parameters in the hyponatremic patient. Avoidance of CPM/EPM is dependent upon recognizing those patients with conditions pre-disposing them to osmotic myelinolysis and then moderating the rate of normalization of the electrolyte imbalance. The morbidity and mortality of CPM/EPM has been greatly reduced by recognition of pre-disposing conditions, increased understanding of the pathophysiology, intensive treatment, and rapid diagnosis and monitoring with advanced neuroimaging.

Keywords: EXTRAPONTINE MYELINOLYSIS; DEMYELINATING SYNDROMES; CENTRAL PONTINE MYELINOLYSIS

Document Type: Research Article

DOI: http://dx.doi.org/10.1179/016164106X110346

Affiliations: 1: Department of Neurology, Louisiana State University School of Medicine, 1501 Kings Highway, Shreveport, LA 71103, USA 2: Department of Pathology, Louisiana State University School of Medicine, 1501 Kings Highway, Shreveport, LA 71103, USA 3: Department of Neurology, Louisiana State University School of Medicine, 1501 Kings Highway, Shreveport, LA 71103, USA; Department of Radiology, Louisiana State University School of Medicine, 1501 Kings Highway, Shreveport, LA 71103, USA

Publication date: 2006-04-01

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