Central pontine myelinolysis
has been associated with severe liver disease, alcoholism, sepsis, and rapid correction of chronic hyponatremia.
The infusion rate should be calculated for each case carefully not to increase serum Na+ levels too quickly which can cause pontine and extrapontine myelinolysis
Differential Diagnoses for MS Vascular Susac Syndrome Central nervous system vasculitis Anti phospholipid syndrome Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy Inflammatory Systemic lupus erythematosus Neuromyelitis optica Sjogren syndrome Sarcoidosis Behcet disease Acute disseminated encephalomyelitis Infectious Lyme neuroborreliosis Syphilis West Nile virus Progressive multifocal leukoencephalopathy Cysticercosis Human lymphotropic virus, types 1/2 HIV or herpes encephalitis Metabolic Mitochondrial diseases Wilson disease B12 deficiency Leukodystrophies Multifocal Lymphoma tumors Gliomastosis cerebri Metastases Other Spinal stenosis Central pontine myelinolysis
Radiation therapy TABLE 4.
Differential considerations, which usually lead to persistent abnormalities, are diffuse axonal injury, multiple sclerosis, lymphoma and-more rarely--extra-pontine myelinolysis
, Marchiafava-Bignami disease and posterior reversible encephalopathy syndrome (PRES).
Cases with Marchiafava-Bignami disease showed thinning or lesions of the corpus callosum; with central pontine myelinolysis
show degradation of myelin sheathing of the white matter in the central pons, and alcoholic cerebellar degeneration is marked by shrinkage of the cerebellar hemispheres and vermis (Victor et al.
The correction of hyponatraemia carries the risk of osmotic demyelination, better known as central pontine myelinolysis
(CPM), although the demyelination is not necessarily confined to the pons.
Glynis suffers from central pontine myelinolysis
, which affects her vision and movement and she is registered as partially disabled.
Osmotic demyelination, or central pontine myelinolysis
, in association with the rapid correction of an acute hyponatremia (ie, <48 hour duration), has not been reported (86) and should never be an impediment to rapidly correcting hyponatremia in symptomatic EAH (7,21-23,26,43,46,54,60).
Neurologic complications after orthotopic liver transplantation including central pontine myelinolysis
Wernicke's encephalopathy and central pontine myelinolysis
associated with hyperemesis gravidarum.