Central pontine myelinolysis in a chronic alcoholic patient with mild hyponatremia: A case report

Correspondence on Letter regarding “Evidence-based hyponatremia management in liver disease”

“…ODS is symmetric, non-inflammatory demyelination of neurons, which can be classified into two types based on location: central pontine myelinolysis and extrapontine myelinolysis. [6][7][8] It occurs as a result of apoptosis of oligodendrocytes and infiltration of myelin degrading macrophages. 8,9 Hyponatremia and overly rapid correction of hyponatremia have been well-known as potent causative factors of ODS.…”

“…Patients with chronic alcohol consumption (the most common) or liver cirrhosis/liver transplantation (third largest group) are more susceptible to ODS because of reduced ability of astrocytes to synthesize new intracellular osmolytes in response to osmotic changes. 4,7,[10][11][12][13][14][15] In a recent study involving 547,544 adult inpatients with cirrhosis, ODS was found to be developed in only 0.02% of patients. It was associated with alcohol-related cirrhosis, young age, and female gender.…”

Rapid Correction of Hyponatremia With Isotonic Saline Leading to Central Pontine Myelinolysis

“…It is thought to be due to the osmotic changes, and the pons' neurons are highly affected because of their delayed response to the osmotic shift. Due to this, intracellular fluid's rapid movement into extracellular space leads to cell shrinkage and apoptosis [ 2 ]. This results in the movement of water out of the neurons in the CSF and the shift of solutes out of the cells [ 2 ].…”

“…Due to this, intracellular fluid's rapid movement into extracellular space leads to cell shrinkage and apoptosis [ 2 ]. This results in the movement of water out of the neurons in the CSF and the shift of solutes out of the cells [ 2 ]. As the pons is the slowest structure of the brain to respond to the osmotic shift, it is the most commonly affected site in CPM.…”

“…Central pontine myelinolysis (CPM), a part of osmotic demyelination syndrome (ODS), was first described in 1959 by Adam and Victor [ 1 ]. Two forms of ODS are known, one of which is CPM and the other is extra-pontine myelinolysis [ 2 ]. CPM is a rare, acute, non-inflammatory, demyelinating disorder characterized by loss of myelin sheath in the neurons of central pons [ 3 ].…”