Outcome of central pontine and extrapontine myelinolysis ( n = 44)

Abstract

The findings in 44 patients (42 of whom were chronic alcoholics) with central pontine myelinolysis show that the outcome does not depend on the severity of neurological deficits during the acute phase of the condition or on concomitant internal diseases, including the degree of hyponatremia. Of the 34 patients for whom follow-up data were available, 32 survived. Of these 11 completely recovered, 11 had some deficits but were independent, and 10 were dependent (4 through disorders of memory or cognition, 3 with tetraparesis, 2 with cerebellar ataxia, 1 with polyneuropathy). The electrophysiological findings did not contribute usefully to the prediction of outcome. Additional neuroradiological diagnostic testing with magnetic resonance imaging was also of no prognostic significance. The extent of the initial pontine lesion was not correlated with the severity of clinical findings during the acute phase of disease, nor was persistence of the pontine lesion as usually seen on magnetic resonance imaging correlated with clinical improvement. We conclude that patients with cerebral myelinolysis survive if the nonspecific secondary complications of transient illnesses such as aspiration pneumonia, ascending urinary tract infection with subsequent septicemia, deep venous thrombosis, and pulmonary embolism can be avoided.

Clinical and Radiologic Correlations of Central Pontine Myelinolysis Syndrome

“…Although a prior study mentioned a similar clinicoradiologic disconnect (based on a single patient whose MRI results did not change despite clinical improvement), 7 previous studies have not attempted to correlate severe radiologic abnormalities on MRI with clinical outcome. A persistently abnormal MRI signal after clinical improvement in CPM has been previously appreciated and has been attributed to residual gliosis.…”

“…6 Another study reported no correlation between the size of the pontine lesion on brain magnetic resonance imaging (MRI) and clinical course; however, besides a single case description, no details or data were provided to support this conclusion. 7 Therefore, we performed this study to evaluate whether any clinical or laboratory data could predict functional outcome in patients with CPM, with special interest in determining whether more extensive pontine T2 signal abnormality was an indicator of poor outcome in these patients.…”

“…Similarly, in a large series of 34 patients with CPM, 65% achieved a good or moderate outcome (no functional deficit or independence despite minor deficits), and a poor outcome was seen in 27%, including a 6% mortality rate. 7 Another recent study of 25 patients found that 46% achieved a favorable outcome. 6 The increasing availability of MRI scans aiding in early diagnosis and improvements in intensive care treatments are likely contributing factors to the noted improvements in outcomes.…”

“Dazed and diffused”: making sense of diffusion abnormalities in neurologic pathologies

“…Conditions associated with osmotic myelinolysis include alcoholism, alcohol withdrawal, malnutrition, liver transplantation, cirrhosis and severe burns [95]. Prognosis is quite variable, with approximately one-third of patients recovering completely, onethird having mild residual neurologic deficits and one-third remaining severely neurologically impaired [96].…”

“…Over the course of weeks, the diffusion abnormalities may completely resolve or demonstrate T 2 shine-through [95,98,99]. Resolution of diffusion abnormalities may predict a better prognosis for the patient [99], although this is controversial [96].…”