Central pontine myelinolysis

Central pontine and extrapontine myelinolysis in children: a review of 76 patients

This study aimed to identify the causes and contributing factors, neurologic presentation, and outcomes of central pontine and extrapontine myelinolysis and to examine any trends in the presentation and course of these disorders over the past 50 years. Seventy-six pediatric cases were identified in the literature. Age, sex, decade of diagnosis, neurologic presentation, outcome, and attributed causes were extracted. The results showed that the diagnosis, course, and outcomes of central pontine and extrapontine myelinolysis clearly have changed over the past few decades. Early cases generally were diagnosed at autopsy as opposed to computed tomography or magnetic resonance imaging more recently. Ninety-four percent of cases prior to 1990 and only 7% of cases from 1990 onward resulted in patient mortality. The decade in which the case was reported was the strongest predictor of outcome (P < .001), followed by sodium dysregulation (P = .045) and dehydration (P = .07).

Benign course of central pontine myelinolysis in a patient with anorexia nervosa

Central pontine myelinolysis is a rare neurologic disorder defined by symmetric demyelination of the central base of the pons. Until recently its outcome was considered invariably poor if not fatal. We report a 15-year-old female patient with severe anorexia nervosa who acutely developed a locked-in syndrome. Magnetic resonance imaging revealed a central pontine lesion. There was no serum sodium abnormality. The corticospinal and corticonuclear tracts were intact, as assessed by serial neurophysiologic studies. Finally, the patient recovered completely both clinically and radiologically. This article discusses these observations in the light of recent reports on similar benign outcomes of central pontine myelinolysis. Although electrolyte imbalances could be overestimated and the clinical significance of the radiologic lesion is uncertain, the functional assessment of the corticospinal and corticonuclear fibers might have prognostic value.

Osmotic demyelination disorders: central pontine and extrapontine myelinolysis

Focal symmetric demyelination in the central nervous system may be precipitated by aggressive correction of a hyper- or hypo-osmolar state and until recently has been associated with a high rate of morbidity and mortality. Specific anatomical locations are more susceptible to demyelination than others, although the mechanism of injury is unknown. Classic clinical and anatomical descriptions associated with a central pontine location have been supplemented by descriptions of patients with unusual symptoms associated with demyelinating lesions in extrapontine locations. The separation of patients with myelinolysis in central pontine and extrapontine locations is possible on the basis of clinical symptoms, and may direct specific pharmacological treatment. Patients at risk of central myelinolysis who are subjected to aggressive osmolar correction may be rescued with appropriate fluid management before brain injury has occurred; once injury is suspected on the basis of neurological symptoms, additional forms of intervention may still improve the outcome. Recent investigation of the molecular basis of the demyelinating process and the adaptive responses of the brain to dysosmolar challenge has allowed for the refinement of standard treatments and has made the osmotic demyelination syndrome a treatable condition with a better than expected prognosis.