ENLmedical.com: Conditions And Concerns: Medical Encyclopedia: Central pontine myelinolysis

Central pontine myelinolysis

Causes and Risks:
The destruction of the myelin sheath inhibits impulse conduction along the nerve cell. The most common cause of this condition is rapid correction of low sodium levels in the body (hyponatremia).

Risks include hyponatremia from any cause. Alcoholism , Wernicke-Korsakoff syndrome , and general ill health and malnutrition associated with serious illnesses (cachexia) increase the risk of central pontine myelinolysis. This condition does not occur spontaneously but results from other conditions that cause the damage.

Prevention:
Gradual controlled correction of hyponatremia may reduce the risk of damage to the nerves of the pons.

Symptoms:

weakness in the face, arms, or legs
- usually affecting both sides of the body
muscle spasms in the face, arms, and/or legs
double vision
reduced vision
confusion , delirium
speech changes, poor enunciation
difficulty swallowing
reduced alertness
- drowsy , sleepy , lethargic
- poorly responsive

Additional symptoms that may be associated with this disease:

Signs and Tests:
Examination may indicate involvement of all four extremities (spastic quadriplegia) or weakness of face, arms, and legs (upper motor neuron syndromes). Reflexes may be abnormal. Eye examination may show loss of control of eye muscles, particularly cranial nerve VI paralysis (see cranial mononeuropathy VI ).

A cranial MRI scan shows abnormality in the brainstem (pons). This is the primary diagnostic study.

Other procedures:

CT scan of the head shows a lesion in the pons.
Brainstem evoked response audiometry (BERA) is abnormal.

This disease may also alter the results of the following tests:

Treatment:
This is an emergency disorder that requires hospitalization for initial diagnosis and treatment. There is no known cure for central pontine myelinolysis and treatment is focused on relieving symptoms.

Double vision may be reduced with the use of an eye patch.

Physical therapy, may help maintain muscle strength, mobility, and function in weakened arms and legs.

Prognosis:
The neurologic damage caused by central pontine myelinolysis is usually persistent. Although not usually a direct threat to life, the disorder can cause serious chronic disability.

Complications:

permanent neurologic losses
decreased ability to work or care for self
decreased ability to interact with others

Call Your Healthcare Provider:
Go to the emergency room or call the local emergency number (such as 911) if seizures , muscle weakness , or other symptoms of central pontine myelinolysis occur.