Advertisement

Central Pontine and Extrapontine Myelinolysis

  • Jacob Valk
  • Marjo S. van der Knaap

Abstract

Central pontine myelinolysis (CPM) is a demyelinative disorder affecting mainly the ventral part of the pons. In some cases CPM is accompanied by extrapontine myelinolysis (EPM, together CPM/EPM). CPM/EPM is not a primary disease but develops rather against a background of other, usually severe conditions, apparently as a complication of the main disease. It occurs mostly in alcoholics but has also been reported in association with diabetic ketoacidosis, psychogenic excessive water drinking, inappropriate antidiuretic hormone secretion, malnutrition, and chronic debilitating diseases. It is probable that the underlying cause of myelinolysis in all these disorders is a derangement of serum sodium concentration, particularly a rapid correction of hyponatremia.

Keywords

Serum Sodium Diabetic Ketoacidosis Thiamine Deficiency Serum Sodium Concentration Centrum Semiovale 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Alberca R, Iriate LM, Rasero P, Villalobos F (1985) Brachial diplegia in central pontine myelinolysis. J Neurol 231: 345–346PubMedCrossRefGoogle Scholar
  2. Ayus JC, Krothapalli RK, Arieff AI (1987) Treatment of symptomatic hyponatremia and its relation to brain damage. N Engl J Med 317: 1190–1195PubMedCrossRefGoogle Scholar
  3. Berlit P (1986) Die zentrale pontine Myelino1yse. Nervenarzt 57: 624–633PubMedGoogle Scholar
  4. Brunner JE (1985) Central pontine myelinolysis in a patient with adrenal insufficiency. Henry Ford Hosp Med J 33: 45–47PubMedGoogle Scholar
  5. Burcar PJ, Norenberg MD, Yarnell PR (1977) Hyponatremia and central pontine myelinolysis. Neurology 27: 223–226PubMedCrossRefGoogle Scholar
  6. Da Cunha C, Bertorini TE, Lawrence J, Witherington JM (1986) Central pontine myelinolysis: a preventable condition. J Tenn Med Assoc 79: 469–472PubMedGoogle Scholar
  7. DeWitt LD, Buonanno FS, Kistler P, Zeffiro T, et al. (1984) Central pontine myelinolysis: demonstration by nuclear magnetic resonance. Neurology 34: 570–576PubMedCrossRefGoogle Scholar
  8. Gerber O, Geller M, Stiller J, Yang W (1983) Central pontine myelinolysis. Resolution shown by computed tomography. Arch Neurol 40: 116–118Google Scholar
  9. Goebel HH, Herman-Ben Zur P (1976) Central pontine myelinolysis. In: Vinken PJ, Bruyn GW, eds. Handbook of clinical neurology, vol 28. Amsterdam: North Holland Publishing Company: 285–316Google Scholar
  10. Goldman JE, Horoupian DS (1981) Demyelination of the lateral geniculate nucleus in central pontine myelinolysis. Ann Neurol 9: 185–189PubMedCrossRefGoogle Scholar
  11. Haan J, Deppe A (1986) Zentrale pontine Myelinolyse bei Alkoholismus. Nervenarzt 57: 609–612PubMedGoogle Scholar
  12. Ingram DA, Traub M, Kopelman PG, Summers BA, et al. (1986) Brain-stem auditory evoked responses in diagnosis of central pontine myelinolysis. J Neurol 233: 23–24PubMedCrossRefGoogle Scholar
  13. Kleinschmidt-DeMasters BK, Norenberg MD (1981) Rapid correction of hyponatremia causes demyelinatinn: relation to central pontine myelinolysis. Science 211: 1068–1070PubMedCrossRefGoogle Scholar
  14. Kleinschmidt-DeMasters BK, Norenberg MD (1982) Neuro-pathologic observations in electrolyte-induced myelinolysis in the rat. J Neuropathol Exp Neurol 41: 67–80PubMedCrossRefGoogle Scholar
  15. Kobuke T (1985) Central pontine myelinolysis accompanied by multifocal pseudocalcifications. Acta Pathol Jpn 35: 1279–1284PubMedGoogle Scholar
  16. Kold A (1986) Hyponatremia: cerebral symptoms and role in central pontine myelinolysis. Acta Neurol Scand 73: 200–202PubMedCrossRefGoogle Scholar
  17. Kold A, Johansen O, Reintoft I, Reske-Nielsen E (1986) Cen- tral pontine myelinolysis. Acta Neurol Scand 73: 260–263PubMedCrossRefGoogle Scholar
  18. Larrue V, Barrère M, Adam Ph, Géraud G, et al. (1984) Myélinolyse centro-pontine d’évolution régressive avec traduction tomodensitométrique. Rev Neurol 140: 576–579PubMedGoogle Scholar
  19. Laureno R, Illowsky Karp I (1988) Pontine and extrapontine myelinolysis following rapid correction of hyponatraemia. Lancet I: 1439–1440Google Scholar
  20. Laureno R (1983) Central pontine myelinolysis following rapid correction of hyponatremia. Ann Neurol 13: 232–242PubMedCrossRefGoogle Scholar
  21. Marra TR (1983) Hemiparesis apparently due to central pontine myelinolysis following hyponatremia. Ann Neurol 14: 687–688PubMedCrossRefGoogle Scholar
  22. Messert B, Orrison WW, Hawkins MJ, Quaglieri CE (1979) Central pontine myelinolysis. Considerations on etiology, diagnosis, and treatment. Neurology 29: 147–160Google Scholar
  23. Michel D, Antoine JC, Ninet J, Pasquier J, et al. (1986) La tomodensitométrie dans la myélinolyse centro-pontine. Presse Med 23: 1081–1083Google Scholar
  24. Mossuto L, Fattapposta F, Rossi F (1986) Central pontine myelinolysis: diagnosis by computed tomography, magnetic resonance and evoked potentials. Ital J Neurol Sci 7: 591–596PubMedCrossRefGoogle Scholar
  25. Narins RG (1986) Therapy of hyponatremia. Does haste make waste? N Engl J Med 314: 1573–1575PubMedCrossRefGoogle Scholar
  26. Norenberg MD (1983) A hypothesis of osmotic endothelial injury. Arch Neurol 40: 66–69PubMedCrossRefGoogle Scholar
  27. Norenberg MD, Leslie KO, Robertson AS (1982) Association between rise in serum sodium and central pontine myelinolysis. Ann Neurol 11: 128–135PubMedCrossRefGoogle Scholar
  28. Okeda R, Kitano M, Sawabe M, Yamada I, et al. (1986) Distribution of demyelinating lesions in pontine and extrapontine myelinolysis–Three autopsy cases including one case devoid of central pontine myelinolysis. Acta Neuropathol 69: 259–266PubMedCrossRefGoogle Scholar
  29. Pfister HW, Einhäupt KM, Brandt T (1985) Mild central pontine myelinolysis: a frequently undetected syndrome. Eur Arch Psychiatr Neurol Sci 235: 134–139CrossRefGoogle Scholar
  30. Rosenbloom S, Buchholz D, Kumar AJ, Kaplan RA, et al. (1984) Evolution of central pontine myelinolysis on CT. AJNR 5: 110–112PubMedGoogle Scholar
  31. Schroth G (1984) Clinical and CT confirmed recovery from central pontine myelinolysis. Neuroradiology 26: 149–151PubMedCrossRefGoogle Scholar
  32. Slager UT (1986) Central pontine myelinolysis and abnormalities in serum sodium. Clin Neuropathol 5: 252–256PubMedGoogle Scholar
  33. Stam J, Oers van MHJ, Verbeeten B (1984) Recovery after central pontine myelinolysis. J Neurol 231: 52–53PubMedCrossRefGoogle Scholar
  34. Steinsapir KD, Vinters HV (1985) Central pontine myelinolysis in a child with the Shwachman-Diamond syndrome. Hum Pathol 16: 741–743PubMedCrossRefGoogle Scholar
  35. Sterns RH, Riggs JE, Schochet SS (1986) Osmotic demyelination syndrome following correction of hyponatremia. N Engl J Med 314: 1535–1542PubMedCrossRefGoogle Scholar
  36. Sztencel J, Baleriaux D, Borenstein S, Brunko E, et al. (1983) Central pontine myelinolysis: correlation between CT and electrophysiologic data. AJNR 4: 529–530PubMedGoogle Scholar
  37. Takeda K, Sakuta M, Saeki F (1985) Central pontine myelinolysis diagnosed by magnetic resonance imaging. Ann Neurol 17: 310–311PubMedCrossRefGoogle Scholar
  38. Thompson DS, Hutton JT, Stears JC, Sung JH, et al. (1981) Computerized tomography in the diagnosis of central and extrapontine myelinolysis. Arch Neurol 38: 243–246PubMedCrossRefGoogle Scholar
  39. Thompson PD, Gledhill RF, Quinn NP, Rossor MN, et al. (1986) Neurological complications associated with parenteral treatment: central pontine myelinolysis and Wernicke’s encephalopathy. Br Med J 292: 684–685CrossRefGoogle Scholar
  40. Wright DG, Laureno R, Victor M (1979) Pontine and extra-pontine myelinolysis. Brain 102: 361–385PubMedCrossRefGoogle Scholar
  41. Wright JR, Yates AJ, Sharma HM, Thibert P (1983) Central pontine myelinolysis following saline treatment of a diabetic rat for dehydration. J Comp Path 93: 509–514PubMedCrossRefGoogle Scholar
  42. Zegers de Bey’ D, Flament-Durand J, Borenstein S, Brunko E (1983) Ocular bobbing and myoclonus in central pontine myelinolysis. J Neurol Neurosurg Psychiatry 46: 564–565CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • Jacob Valk
    • 1
  • Marjo S. van der Knaap
    • 2
  1. 1.Department of Diagnostic Radiology and NeuroradiologyFree University HospitalAmsterdamThe Netherlands
  2. 2.Department of Child NeurologyAcademic HospitalUtrechtThe Netherlands

Personalised recommendations