Central pontine myelinolysis and extrapontine myelinolysis: literature review and case report
https://doi.org/10.24884/1607-4181-2020-27-2-72-78
Abstract
Central pontine myelinolysis (CPM) is a concentrated, symmetric, non-inflammatory demyelination within the central basis pontis. In 10 % of patients with СРМ, demyelination also occurs in extrapontine regions: the mid brain, thalamus, basal nuclei, and cerebellum. Demyelination occurs in regions of compact interdigitation of white and gray matter as a result of cellular edema, which is caused by fluctuating osmotic forces, results in compression of fiber tracts. The most frequent cause of abrupt change in osmotic pressure is the rapid sodium correction of prolonged hyponatremia. In case that we report, there is a combination of central pontine and extrapontine myelinolysis, which occurs in 71-year-old woman owing to rapid sodium correction of prolonged hyponatremia which by turn developed due to salt-free diet, improper antihypertensive therapy and overheating. The diagnosis was confirmed by magnetic resonance imaging (MRI). The treatment led to significant decrease of neurological deficit.
About the Authors
E. M. Sheveleva
Pavlov University
Russian Federation
Russian Federation
Sheveleva Ekaterina M. - 2-year Resident of the Department of Neurology, Pavlov University.
6-8, L'va Tolstogo str., Saint Petersburg, 197022.
L. G. Zaslavskii
Pavlov University; Leningrad Regional Clinical Hospital
Russian Federation
Russian Federation
Zaslavskii Leonid G. - Dr. of Sci. (Med.), Professor of the Department of Neurology, Pavlov University; Head of the Department of Neurology, Leningrad Regional Clinical Hospital.
6-8, L'va Tolstogo str., Saint Petersburg, 197022.
A. G. Kovelenov
Leningrad Regional Clinical Hospital
Russian Federation
Russian Federation
Kovelenov Alexander G. - Radiologist of the MRI Department, Leningrad Regional Clinical Hospital.
Saint Petersburg.
E. A. Skorniakova
Leningrad Regional Clinical Hospital
Russian Federation
Russian Federation
Skorniakova Evgeniia A. - Neurologist of the Department of Neurology, Leningrad Regional Clinical Hospital.
Saint Petersburg.
References
1. Adams R. D., Victor M., Mancall E. L. Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients. AMA Arch Neurol Psychiatry. 1959 Feb;81(2):154-172.
2. Crivellin C., Cagnin A., Manara R., Boccagni P., Cillo U., Feltracco P. et al. Risk factors for central pontine and extrapontine myelinolysis after liver transplantation: a single-center study. Transplantation. 2015 Jun.;99(6):1257-1264. Doi: 10.1097/TP.0000000000000496.
3. Karp B. I., Laureno R. Pontine and extrapontine myelinolysis: a neurologic disorder following rapid correction of hyponatremia. Medicine (Baltimore). 1993 Nov;72(6):359-373.
4. Laureno R., Karp B. I. Myelinolysis after correction of hyponatremia. Ann Intern Med. 1997 Jan 1;126(1):57-62. Doi: 10.7326/0003-4819-126-1-199701010-00008.
5. Singh T. D., Fugate J. E., Rabinstein A. A. Central pontine and extrapontine myelinolysis: a systematic review. Eur J Neurol. 2014 Dec;21(12):1443-1450. Doi: 10.1111/ene.12571.
6. Singh N., Yu V. L., Gayowski T. Central nervous system lesions in adult liver transplant recipients: clinical review with implications for management. Medicine (Baltimore). 1994 Mar;73(2):110-118. Doi: 10.1097/00005792-19940300000004.
7. Martin R. J. Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes. J Neurol Neurosurg Psychiatry. 2004 Sep;75 Suppl 3:iii22- iii28. Doi: 10.1136/jnnp.2004.045906.
8. DeWitt L. D., Buonanno F. S., Kistler J. P. et al. Central pontine myelinolysis: demonstration by nuclear magnetic resonance. Neurology. 1984 May;34(5):570-576. Doi: 10.1212/wnl.34.5.570.
9. Graff-Radford J., Fugate J. E., Kaufmann T. J., Mandrekar J. N., Rabinstein A. A. Clinical and radiologic correlations of central pontine myelinolysis syndrome. Mayo Clin Proc. 2011 Nov;86(11):1063-1067. Doi: 10.4065/mcp.2011.0239.
10. Kumar S., Fowler M., Gonzalez-Toledo E., Jaffe S. L. Central pontine myelinolysis, an update. Neurol Res. 2006 Apr;28(3):360-366. Doi: 10.1179/016164106X110346.
Review
For citations:
Sheveleva E.M., Zaslavskii L.G., Kovelenov A.G., Skorniakova E.A. Central pontine myelinolysis and extrapontine myelinolysis: literature review and case report. The Scientific Notes of the Pavlov University. 2020;27(2):72-78. (In Russ.) https://doi.org/10.24884/1607-4181-2020-27-2-72-78
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