Central Pontine Myelinolysis

Central Pontine Myelinolysis

Article
Brain & Nerve
Diseases & Conditions
Contributed byKrish Tangella MD, MBANov 15, 2019

What are the other Names for this Condition? (Also known as/Synonyms)

  • CPM (Central Pontine Myelinolysis)
  • Extrapontine Myelinolysis
  • Osmotic Demyelination Syndrome

What is Central Pontine Myelinolysis? (Definition/Background Information)

  • Central Pontine Myelinolysis (CPM) is a life-threatening neurological disorder, in which a part of the brain called the pons, is damaged
  • The damage occurs when an individual, who has low sodium levels in blood is given sodium replacement treatment, at a fast rate
  • It is recommended that individuals, who have low levels of sodium in blood, be given sodium replacement at a slow rate, so that the body tissues can gradually adapt itself to the treatment. A rapid treatment with sodium causes fluid imbalances within the cells, resulting in severe damage
  • The brain tissue is very sensitive to changes in fluid levels within the brain cells. Hence, brains cells in the pons, are particularly vulnerable to the rapid correction of sodium levels. Rarely, CPM may be caused, when increased sodium levels (termed hypernatremia) are corrected too rapidly
  • Central Pontine Myelinolysis causes signs and symptoms, such as difficulty speaking, swallowing, and paralysis of various parts of the body
  • There is no standard treatment or cure for Central Pontine Myelinolysis. The prognosis for CPM is poor, even with treatment. Individuals, who survive the condition, can have residual neurological signs and symptoms

Who gets Central Pontine Myelinolysis? (Age and Sex Distribution)

  • Central Pontine Myelinolysis is a life-threatening emergency that occurs worldwide; individuals of all ages may be affected
  • Both male and female may be affected by CPM
  • All racial and ethnic groups are prone to this disorder

What are the Risk Factors for Central Pontine Myelinolysis? (Predisposing Factors)

The risk factors of Central Pontine Myelinolysis include:

  • It can been seen in individuals having symptoms, due to chronic alcohol withdrawal
  • Individuals, who have undergone stem cell transplantation and liver transplant
  • Liver failure causing malnutrition and fluid imbalance
  • Severe hyperemesis gravidarum, causing excessive vomiting leading to electrolyte imbalances
  • Severe burns causing fluid loss and subsequently electrolyte imbalances
  • Malnutrition resulting in vitamin deficiencies
  • Electrolyte disorders caused excessive vomiting or diarrhea
  • AIDS, with immune-compromised immune system
  • Peritoneal dialysis that may cause hyponatremia

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Central Pontine Myelinolysis? (Etiology)

  • Central Pontine Myelinolysis is a complication of the treatment of low sodium levels in the body. Low sodium levels in blood is referred to as hyponatremia
  • Rapid treatment with sodium causes imbalance in fluids within the cells, leading to severe damage of the cells. During such a rapid administration of sodium, the brain tissue may be affected
  • The brain tissue is very sensitive to fluid change levels within the brain cells. In particular, the brains cells in the pons region are especially vulnerable to such rapid sodium level corrections
  • In some rare cases, CPM may even be caused, when elevated sodium levels (a condition termed as hypernatremia) are rapidly corrected through treatment

What are the Signs and Symptoms of Central Pontine Myelinolysis?

Signs and symptoms of Central Pontine Myelinolysis depend on the extent of damage, and the part of the brain that is damaged. Some of the signs and symptoms include:

  • Difficulty in speaking
  • Difficulty in swallowing
  • Double vison
  • Muscle cramps
  • Convulsions
  • Hallucinations
  • Poor reflexes
  • Paralysis of various parts of the body
  • Loss of sensation in various parts of the body
  • Altered mental status with loss of consciousness

How is Central Pontine Myelinolysis Diagnosed?

A diagnosis of Central Pontine Myelinolysis would involve:

  • Physical examination with evaluation of medical history: A through neurological examination is important
  • Complete blood count
  • Blood analysis of various electrolytes
  • CT scan of head and neck
  • Magnetic resonance imaging (MRI) scan of the brain
  • Electroencephalogram (EEG) to study brain electrical activity

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Central Pontine Myelinolysis?

Complications of Central Pontine Myelinolysis may include:

  • Individuals, who survive an episode of Central Pontine Myelinolysis, can have permanent neurological damage. This may include permanent paralysis, tremors, walking difficulties, difficulties in keeping balance
  • Individuals may suffer from “locked-in syndrome” - this is a condition where, though the individual is completely aware of their surroundings, they are unable to move any of the body muscles, except their eyes. The individuals are unable to even speak
  • Infection of lungs can occur (pneumonia)
  • Formation of blood clots in the legs (deep vein thrombosis)
  • In some cases, the condition may result in coma, or even death

How is Central Pontine Myelinolysis Treated?

There is no cure for Central Pontine Myelinolysis, nor does any specific treatment exist.

  • The treatment includes supportive treatment, such as providing assistance for breathing and eating
  • Physical therapy may help individuals, who have weaknesses and paralysis in various parts of the body
  • Occupational therapy can help individuals with their daily/regular activities
  • Slow correction of low blood sodium levels is very important

How can Central Pontine Myelinolysis be Prevented?

The main cause of Central Pontine Myelinolysis is a rapid correction of low sodium levels in the body. Hence, the slow correction of low levels of sodium would prevent its occurrence. In this manner, the incidence rate of CPM can also be greatly reduced.

What is the Prognosis of Central Pontine Myelinolysis? (Outcomes/Resolutions)

  • The prognosis of Central Pontine Myelinolysis is generally poor, even with treatment. Many individuals have residual neurological damage, even if they are able to recover from the condition
  • An early diagnosis and appropriate treatment may decrease the severity of Central Pontine Myelinolysis

Additional and Relevant Useful Information for Central Pontine Myelinolysis:

  • The sodium blood test is a test to measure the levels of dissolved sodium in blood. It is a routinely ordered test that provides information about a possible electrolyte unbalance, which could cause a variety of ailments

The following article link will help you understand sodium blood test:

http://www.dovemed.com/common-procedures/procedures-laboratory/sodium-blood-test/

Was this article helpful

On the Article

Krish Tangella MD, MBA picture
Approved by

Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

0 Comments

Please log in to post a comment.

Related Articles

Test Your Knowledge

Asked by users

Related Centers

Loading

Related Specialties

Loading card

Related Physicians

Related Procedures

Related Resources

Join DoveHubs

and connect with fellow professionals

Related Directories

Who we are

At DoveMed, our utmost priority is your well-being. We are an online medical resource dedicated to providing you with accurate and up-to-date information on a wide range of medical topics. But we're more than just an information hub - we genuinely care about your health journey. That's why we offer a variety of products tailored for both healthcare consumers and professionals, because we believe in empowering everyone involved in the care process.
Our mission is to create a user-friendly healthcare technology portal that helps you make better decisions about your overall health and well-being. We understand that navigating the complexities of healthcare can be overwhelming, so we strive to be a reliable and compassionate companion on your path to wellness.
As an impartial and trusted online resource, we connect healthcare seekers, physicians, and hospitals in a marketplace that promotes a higher quality, easy-to-use healthcare experience. You can trust that our content is unbiased and impartial, as it is trusted by physicians, researchers, and university professors around the globe. Importantly, we are not influenced or owned by any pharmaceutical, medical, or media companies. At DoveMed, we are a group of passionate individuals who deeply care about improving health and wellness for people everywhere. Your well-being is at the heart of everything we do.

© 2023 DoveMed. All rights reserved. It is not the intention of DoveMed to provide specific medical advice. DoveMed urges its users to consult a qualified healthcare professional for diagnosis and answers to their personal medical questions. Always call 911 (or your local emergency number) if you have a medical emergency!