5 year old girl with central pontine myelinolysis following pediatric living donor liver transplantation (Pediatr Transplant 2014;18:E120) 1 However, this condition should be considered in any patient with alcohol dependence syndrome with brainstem signs, even when no sodium flux has taken place. Abstract The clinical, radiologic, and neuropathologic findings in 13 patients with central pontine myelinolysis were reviewed. It may coexist with extrapontine myelinolysis (EPM), where it involves lesions outside pons, i.e., in caudate and lentiform nuclei, putamen, thalami, cerebellum, hippocampus, and cerebral cortex. Pontine myelinolysis described historically is now part of a syndrome termed "osmotic demyelination syndrome" and it has two distinct entities: Central pontine myelinolysis (CPM) where only pons is involved and extra pontine myelinolysis (EPM), where structures other than the pons are involved. Nearly all reports on nonfatal cases describe severe clinical syndromes with tetraparesis, bulbar palsy, and coma. Central pontine myelinolysis (CPM) is a severe neuropsychiatric complication of liver transplantation.16,126 The incidence after liver transplantation is 5% to 10%. Central pontine and/or cerebellar myelinolysis can be caused by sudden, severe, and sustained hyperglycemia, especially when another risk factor (in this case, liver cirrhosis) is present. Central pontine myelinolysis (CPM) occurs in the setting of rapidly corrected hyponatremia, especially in chronically debilitated patients. A rare disorder featuring an area of severe loss of myelin in nerve fibres running through the middle of the PONS in the brainstem. Download Citation | On Oct 15, 2022, Cleofina Furtado and others published Radiological Appearance and Imaging Techniques in the Diagnosis of Advanced Central Pontine Myelinolysis | Find, read and . 7,8 When demyelination is found in areas outside of the pons, the disorder is referred to as either extrapontine myelinolysis (EPM) or central and extrapontine myelinolysis (CPEPM). No electrolyte abnormalities were noted during hospitalization. 1987 . CPM and extrapontine demyelination (EPM) are together termed osmotic demyelination syndrome (ODS), a known and serious complication of acute correction of hyponatremia. Central pontine myelinolysis (CPM) is a neurologic disorder once thought to be uniformly fatal. Serial magnetic resonance imaging (MRI) demonstrated characteristic abnormalities within the pons at the onset of the disease, whereas computerised tomography was normal. CPM is a concentrated, often symmetric, noninflammatory demyelination within the central basis pontis. . Int J Pediatr 2012 : 753526, 2012 17. . After ICU discharge, central pontine myelinolysis was diagnosed by magnetic resonance imaging. 2,3 however, with advances in diagnostic imaging techniques Antemortem computed tomography (CT) had been performed in nine, and ante- or postmortem magnetic resonance (MR) imaging in 11. Antemortem computed tomography (CT) had been performed in nine, and ante- or postmortem magnetic resonance (MR) imaging in 11. The neurologic manifestations associated with overly rapid correction have been called the osmotic demyelination syndrome (ODS; formerly called central pontine myelinolysis or CPM). Central pontine myelinolysis (CPM) is a noninflammatory, demyelinating condition that has been described mostly in the context of rapid correction of hyponatraemia. With the introduction of CT and MRI there was an increasing number of reports on nonfatal cases of CPM. Central pontine myelinolysis (CPM) was first described as a disease affecting the alcoholics and the malnourished by Adams and colleagues in 1959 [1]. The situation is usually seen in the setting of rapid or prolonged overcorrection of the hyponatraemia. Central pontine myelinolysis is characterized by the occurrence of acute demyelinating lesions of cells in the pons secondary to abrupt oscillations of serum osmolarity. We present a case of a 45-year-old female with an . Central pontine myelinolysis (CPM) is a neurological disorder that most frequently occurs after too rapid medical correction of sodium deficiency (hyponatremia). Explain the prevention of central pontine myelinolysis by adjusting the rate at which sodium should be corrected. [10] Central pontine myelinolysis (CPM) is a rare condition characterised by spastic tetraparesis, pseudobulbar palsy and the 'locked-in syndrome . In one patient studied serially, ADC values normalized by 3 weeks after tetraplegia. Chronic alcoholism associated CPM tends to be benign with a favorable prognosis compared to CPM secondary to rapid correction of hyponatremia. Introduction . 93,94 Hyponatremia frequently precedes central pontine myelinolysis, . 94 . Central pontine myelinolysis (CPM), also known as osmotic demyelination syndrome (ODS), is a rare demyelinating disorder characterized by the loss of myelin in the center of the basis pontis ().CPM was originally considered to be the result of excessively rapid correction of slowly progressive hyponatremia in patients with chronic medical conditions, such as chronic alcoholism . Holden RW, Roos KL. Definition Central pontine myelinolysis (CPM) is a neurological disorder that most frequently occurs after too rapid medical correction of sodium deficiency (hyponatremia). It is usually caused by electrolytic . He first detailed the entity in a group of malnourished and alcoholic patients. As will be described below, almost all patients who develop ODS present with a serum sodium concentration of 120 mEq/L or less. The Pons is situated in the brainstem. 2 In these patients, a direct toxic effect of alcohol may play an important role in the . Nearly all reports on nonfatal cases describe severe clinical syndromes with tetraparesis, bulbar palsy, and coma. central pontine myelinolysis. Central pontine myelinolysis (CPM) is a neurological condition that happens in the pons area of your brain. Central pontine myelinolysis (CPM) is a non-inflammatory demyelinating lesion of the pons. In CPM, a rapid increase of sodium to correct low sodium levels (hyponatremia) damages nerve cells. AJNR Am J Neuroradiol 2004; 25(2): 210-213. The condition may occur in alcoholism, liver disease, kidney . Central pontine myelinolysis and extrapontine myelinolysis are collectively called the osmotic demyelination syndromes. Clinical and MRI findings correlate early in the course of CPM but clinical recovery predates MRI improvement by several months, and Serial magnetic resonance imaging demonstrated characteristic abnormalities within the pons at the onset of the disease. Central pontine myelinolysis (CPM), often referred to as osmotic demyelination syndrome, is most commonly seen in the setting of rapid correction of hyponatraemia. Central pontine myelinolysis (CPM) is an acute demyelinating neurological disorder affecting primarily the central pons and is frequently associated with rapid correction of hyponatremia. Clinical improvement was . Chronic alcoholism or rapid correction of hyponatremia was present in over 75% of cases. Conclusions : Adult-onset laryngomalacia is a rare cause of upper airway obstruction but should be considered as a cause of postoperative extubation failure. Conversely, hyperglycemic hyperosmolarity syndrome (HHS) develops in patients with type 2 diabetes who still have some insulin secretory . It often presents with dysphagia, dysarthria, quadriplegia, encephalopathy, or coma. Central pontine myelinolysis (CPM) is a neurologic disorder once thought to be uniformly fatal. Medline, Google Scholar; 6 Abbott R, Silber E, Felber J, Ekpo E. Osmotic demyelination syndrome. The imaging features are usually more commonly seen on MR in the presence of a normal CT of the brainstem, MR . Myelinolysis, Central Pontine / diagnosis There is progressive failure of verbal articulation (dysarthria) and spastic paralysis in all four limbs (quadriplegia). The case of a normonatremic, alcoholic man who presented with a combination of dementia, cerebellar findings, and resting tremor is discussed, discussing the pathophysiology, differential diagnosis, and management of central pontine myelinolysis. A special imaging characteristic of Wilson's disease is termed "the face of the giant panda", which is a feature resulting from the sparing of the red nuclei within a diffuse midbrain hyperintensity. J Comput Assist Tomogr. (a) demonstrates central pons low signal intensity (white arrow). On rare occasions, demyelination occurs outside the pons and is termed extrapontine myelinolysis (EPM). Differential diagnosis of Central Pontine Myelinolysis includes infarct, metastasis, glioma, multiple sclerosis, encephalitis, radiotherapy and chemotherapy (3).However,concomitant involvement of the pons and basal ganglia is specific for Osmotic Myelinolysis (7).In such cases, the imaging differential diagnosis includes hypoxia, Leigh disease . Introduction. The current recommendations are a range from 8-12 mEq/L per 24 hours. Conventional CT and MR imaging findings lag the clinical . Central pontine myelinolysis can occur due to hyperglycemia even with normal serum sodium. It is precipitated by the rapid correction of severe chronic hyponatraemia. However, the neuroimaging findings were in line with central pontine myelinolysis . The area involved is usually confined to the basal part of the pons but occasionally involves the tegmentum also. Central pontine myelinolysis is a neurological disorder. Central pontine myelinolysis is an acute non-inflammatory demyelinating disorder. Histology showed demyelination with astrocytosis and infiltration by lymphocytes and macrophages. 1 - 6 Identification of the importance of severe osmotic stress in . Central Pontine Myelinolysis (CPM) is a clinically heterogeneous neurological disorder of demyelination in the pons, usually from rapid correction of hyponatremia.1,2 A 38-year-old woman with uncontrolled type 1 DM (hbA1c 12.8%) was admitted for diabetic ketoacidosis (731mg/dl blood glucose). Objective: To characterize clinical and radiologic features of patients with central pontine myelinolysis (CPM) and identify variables that predict outcome. Early diagnosis of central pontine myelinolysis with diffusion weighted imaging. 127 It consists of demyelination in the center of the basis pontis. Typical imaging findings in an appropriate clinical scenario Radiology description "Trident" or "bat wing" shaped area of restricted diffusion in central pons . Her condition, including gait disturbances, truncal ataxia, and dysarthria-presumed to be due to severe alcohol abuse-had deteriorated during treatment of ambulatory-acquired pneumonia. Therefore, a diagnosis of CPM should be considered in diabetic patients with poor glycemic control who present with neurological symptoms like quadriparesis, even in the absence of derangements of serum sodium or other predisposing factors. We reviewed nine patients with CPM and compared the size of the pontine lesion on . 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