Central pontine myelinolysis

Abstract

A 45-year-old woman was found dead on a sofa in her flat by her male partner. She was known as a chronic alcoholic with nearly three decades of heavy alcohol abuse and more than 40 clinical treatments for alcohol withdrawal in her previous medical history. Because of the young age of the deceased, the unknown circumstances surrounding her death and both an undetermined cause and manner of death, a medicolegal autopsy was performed.External examination of the body showed an overweight adult female (body mass index: 29) without any external injuries. At autopsy, all inner organs appeared pale. Several mucosal lacerations of the lower esophagus were present. 150 ml of bloody fluid were found in the stomach. A large amount of tarry stool was present in the small and large bowel. In addition, edema of the lungs and fatty liver were seen. The most remarkable finding was a region of gray and light brownish discoloration, measuring 1 cm in diameter, that was located in the middle of the base of the pons within the brainstem, corresponding to central pontine myelinolysis (CPM) (Figs. 1, 2). Histology of the pons lesion verified the diagnosis of CPM by revealing demyelinization with reactive astrocytes and large numbers of foamy lipid-laden macrophages and scanty lymphocytes (Figs. 3, 4).Toxicology results were negative for both alcohol and drugs.Death was attributed to exsanguination due to MalloryWeiss syndrome of the lower esophagus.

Pseudo-Central Pontine Myelinolysis

“…8,9 At autopsy, CPM can present with a dark central lesion of the pons. 3,4 Figures 5 and 6 show examples of true CPM at autopsy. The focal discoloration seen in CPM can be similar in appearance to the examples of "pseudo-CPM" presented here of neuronal heterotopia (Fig.…”

“…At autopsy, CPM can present with a dark central lesion of the pons 3,4 Figures 5. and 6 show examples of true CPM at autopsy.…”

“…1,2 In CPM cases, this is characterized pathologically by lesions of the central pons, appearing as a dark central abnormality. 3,4 In the forensic pathology setting, CPM may be found at autopsy and can be considered a potential cause or mechanism of death; such cases typically occur in the setting of chronic alcoholics. 5,6 In this case report, we present 2 autopsy cases where gross examination of the pons revealed a lesion suggestive of CPM; however, subsequent microscopic analysis indicated otherwise.…”

“…Central pontine myelinolysis (CPM), first described in 1959, occurs in association with rapid correction of serum sodium concentration after a period of hyponatremia 1,2 . In CPM cases, this is characterized pathologically by lesions of the central pons, appearing as a dark central abnormality 3,4 . In the forensic pathology setting, CPM may be found at autopsy and can be considered a potential cause or mechanism of death; such cases typically occur in the setting of chronic alcoholics 5,6 .…”

Alcohol and acute pancreatitis contributing to central pontine myelinolysis

“…Central Pontine myelinolysis (CPM), also known as osmotic demyelination syndrome, is defined as a neurological disorder caused by damage of the myelin sheath of the nerve cells in the pons [1]. It was first described in 1959 as a disease affecting alcoholics and the malnourished [2]. The cause was not known then but the authors suspected either a toxin or a nutritional deficiency.…”