Mild central pontine myelinolysis: a frequently undetected syndrome

Abstract

Over a period of 1 year we diagnosed central pontine myelinolysis (CPM) in five patients all of whom survived, two of them with complete functional recovery despite extensive lesions on cranial computerized tomography and magnetic resonance imaging. Diagnosis was based upon the combination of an acute brainstem dysfunction with typical neuroradiological features; a history of chronic alcoholism or a preceding hyponatremia may serve as a diagnostic hint. The spectrum of symptoms ranged from severe tetraplegia and cranial nerve palsies to latent signs of pyramidal tract lesions and discrete ocular motor abnormalities. In two patients pontine and extrapontine manifestations of demyelination were confirmed neuroradiologically; in one patient a solely extrapontine manifestation was present. Thus it is reasonable that: (1) the incidence of comparatively mild forms of CPM as well as extrapontine manifestations are more frequent than hitherto assumed, (2) the clinical outcome of the syndrome is better than expected from earlier fatal case reports and is quite independent of the extent of the lesion as it appears with brain imaging methods.

Central Pontine Myelinolysis

“…The clinical picture varied depending on the brain areas and the ascending or descending tracts in the brainstem involved [13]. While in some patients the course of disease is silent [37], others experience relapses [38]. The cardinal symptoms include psychiatric changes, disturbances of consciousness, disturbed function of caudal cranial nerves with signs of pseudobulbar palsy, dysarthria and dysphagia, as well as spastic paraparesis and tetraparesis of various degrees of severity, epileptic seizures and hypotension.…”

“…In some patients, CPM shows a silent course [37], while in others relapses are seen [38]. The cardinal symptoms include psychiatric changes, disturbances of consciousness, disturbed function of the caudal cranial nerves with signs of pseudobulbar palsy, dysarthria and dysphagia, as well as spastic paraparesis and tetraparesis of various degrees of severity, epileptic seizures, ataxia, depressed or absent reflexes, lethargy and hypotension.…”

“…The majority of patients who survive CPM reveal permanent neurological damage. However, there are an increasing number of reports with respect to the remission of neurological damage thanks to the use of specific therapeutic approaches [37, 46, 73, 74]. …”

“…These changes result from demyelination of the acoustic pathways within the pons. They were particularly helpful before the large-scale introduction of CT; however, they are not specific enough [52]and not always present [5, 37, 52]. …”

Osmosinės mielinolizės sindromas (centrinė tilto ir ekstrapontininė mielinolizė): literatūros apžvalga ir atvejo pristatymas

“…Kli ni ki në ei ga yra dvi fa zë, ta èiau kai ku riems pa cien tams ga li bû ti ir besimp to më [29]. Kla si ki niu at ve ju la ten ci jos pe ri ode pacien tas at vyks ta su hi po nat re mi jos kom pli ka ci jo mis (trauku liai, en ce fa lo pa ti ja), ku rie grei tai ið nyks ta, pa sie kus normo nat re mi jà.…”