Thursday February 2, 2006
What's new on Central pontine myelinolysis (CPM)
Central pontine myelinolysis, a demyelinating disorder of central pons charaterized by pseudobulbar palsy and spastic quadriplegia, is co-diagnosed by specific MRI findings under know clinical settings or risk factors. Specific MRI findings are increased signal in the central pons on fluid-attenuated inversion recovery images (FLAIR) and hypointense lesions on T1-weighted images. 5 decades ago it was described in chronic alcoholism but over the time it was found in association with malnourished status, renal failure, diabetes mellitus, and post-orthotopic liver transplantation and came to known as hallmark of rapid correction of hyponatremia - but in recent years it has been reported with hypophosphetemia and in DKA (Diabetes Ketoacidosis) despite normal sodium level or no rapid correction of sodium. Treatment is supportive and prognosis thought to be universally fatal. In recent years there are reports of good recovery and long-term survival with proper supportive management.
See nice review article Central Pontine Myelinolysis from emedicine.com
References: Click to get article/abstract: (appears in popup window and second popup overwrites first popup)
1. Central Pontine Myelinolysis Following Hemodialysis - grand round at Depatment of Medicine, Maulana Azad Medical College, New Delhi
2. MR imaging of seven presumed cases of central pontine and. extrapontine myelinolysis. -Acta Neurobiol. Exp. 2001, 61: 141-144.
3. Management and Treatment of Psychotic Manifestations in Older Patients with Alcoholism: Part II - Clinical Geriatrics: 2004;12:33-40
4. Central pontine myelinolysis temporally related to hypophosphataemia - Journal of Neurology Neurosurgery and Psychiatry 2003;74:820
5. Central pontine myelinolysis in a patient with diabetic ketoacidosis - The Journal of Critical Illness - Vol. 20, No. 4 - December 2005
6. Parkinsonism and recovery in central and extrapontine myelinolysis - Neurology India, Vol. 53, No. 2, April-June, 2005, pp. 219-220