Hyponatremia and central pontine myeIinolysis

Abstract

Autopsy in a patient with severe hyponatremia showed central pontine myelinolysis. Review of our patients with central pontine myelinolysis and those described in the English literature to data disclosed that 61 percent had documented hyponatremia. While the exact mechanism involving hyponatremia and central pontine myelinolysis cannot be defined, a circumstantial relationship is apparent. The purpose of this paper is to emphasize this relationship and to suggest that the possibility of central pontine myelinolysis be considered in any patient with hyponatremia and neurologic dysfunction.

Auditory Evoked Responses and Computerized Tomography in Central Pontine Myelinolysis

“…Most cases were described in alcoholics but electrolyte imbalance especially hyponatremia has been stressed as occurring in the majority of patients (Burcar et al, 1977). C P M has also been described in various other diseases including liver disease, Wilson's Disease, severe burns, amyloidosis and cerebral trauma.…”

“…More than one hundred and ten cases of central pontine myelinolysis (CPM) have now been reported following the initial description of the disease by Mancall and Adams in 1959 (Burcar et al, 1977;Goebel and Zur, 1972;Messert et al, 1979).…”

Human cerebral osmolytes during chronic hyponatremia. A proton magnetic resonance spectroscopy study.

“…An abrupt fall in serum sodium concentration ( [Na+]) is associated with seizures, respiratory arrest, coma, and death (1). Conversely, aggressive treatment of hyponatremia increases the risk for demyelinating lesions of white matter (2)(3)(4). Hence, the risks of prolonging the hyponatremic state must be balanced against the iatrogenic consequences of prompt correction.…”

Mielinólise pontina central e extra-pontina em paciente alcoolista sem distúrbios hidro-eletrolíticos: relato de caso

“…Mais tarde, com a descrição de vários casos de MPC, observou-se que 10% deles apresentavam concomitantemente áreas de mielinólise fora da ponte, caracterizando, portanto, a mielinólise extra-pontina 3 . Já nos anos 70 se estabeleceu uma forte correlação de MPC e MEP com a presença de hiponatremia e a rápida correção deste distúrbio 4,5 . MPC/MEP são enfermidades descritas tanto em crianças como em adultos de todas as idades, cuja incidência é de difícil precisão.…”