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Central Pontine Myelinolysis

Last updated Nov. 15, 2019

Approved by: Krish Tangella MD, MBA, FCAP

Central Pontine Myelinolysis (CPM) is a life-threatening neurological disorder, in which a part of the brain called the pons, is damaged.

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:


What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Oct. 2, 2014
Last updated: Nov. 15, 2019