Resolution of MRI Findings in Central Pontine Myelinosis Associated With Hypokalemia

Patel, Shomeet; Parish, David C.; Patel, Rajendrakumar M.; Grimsley, Edwin W.

doi:10.1097/maj.0b013e318068b224

Cited by 12 publications

(12 citation statements)

References 9 publications

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“…Reports of CPM occurring with hypokalaemia in the absence of sodium abnormalities are however scarce, with only 3 cases being described since 1990. [5][6][7] This case reports describes a rare example of CPM occurring with hypokalaemia and eunatraemia thus supporting the suggestion that there are factors other than abnormalities in sodium that are associated with the development of CPM.…”

supporting

confidence: 53%

Eunatraemic Hypokalaemic Central Pontine Myelinolysis in an Alcoholic Lady With Bulimia

Pegg

Exley

Punekar

et al. 2013

J Neurol Neurosurg Psychiatry

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supporting

confidence: 53%

Eunatraemic Hypokalaemic Central Pontine Myelinolysis in an Alcoholic Lady With Bulimia

Pegg

Exley

Punekar

et al. 2013

J Neurol Neurosurg Psychiatry

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“…[8] Adams et al ., described CPM as a unique clinical entity in 1958. [9] Several case reports illustrate, that hyperemesis causing hypernatremia, hypokalemia, or hypophosphatemia eventually lead to CPM.…”

Section: Discussionmentioning

confidence: 99%

Wernicke′s encephalopathy following hyperemesis gravidarum

Chandwani¹,

Kantor²,

Sarma³

et al. 2014

Indian Journal of Critical Care Medicine

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Wernicke's encephalopathy (WE) is a potentially reversible yet serious neurological manifestation caused by vitamin B1(thiamine) deficiency. It is commonly associated with heavy alcohol consumption. Other clinical associations are with hyperemesis gravidarum (HG), starvation, and prolonged intravenous feeding. Most patients present with the triad of ocular signs, ataxia, and confusion. It can be associated with life-threatening complication like central pontine myelinolysis (CPM). We report two cases of WE following HG, with two different outcomes.

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“…1b) and diffusion (Fig. 1c) weighted images (WI) and was compatible with CPM [1,2]. The pontine lesion was not detected on T1WI and no contrast was given due to the pregnancy.…”

mentioning

confidence: 91%

“…In low serum sodium situations water flowing freely across cell membranes, causes vasogenic brain edema [1,2] and indeed early pathological changes in CPM typically show microscopic intramyelinic edema and not demyelination [4]. In correcting the hyponatremia, if the rate of rise in tonicity is faster than the rate at which organic osmoles can be synthesized and/or transported into the cells, the cells will shrink and brain dehydration results in injury to oligodendrocytes [1,2], with predilection of the lesion to the pons [1]. Nevertheless, there is still some controversy because CPM has been described in patients with normal serum sodium concentrations [3].…”

mentioning

confidence: 99%

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Salt-free diet and pregnancy-related central pontine myelinolysis: “To diet or not?”

2010

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Central pontine myelinolysis (CPM) is a rare medical condition that has primarily been associated with alcoholism, chronic malnutrition, certain surgical procedures, and serum sodium imbalances with rapid correction [1]. The condition has also been reported to be pregnancy-related, however complicated by hyperemesis gravidarum [2, 3], resulting in electrolyte disturbances, including hypokalemia [2] and possible hyponatremia [3]. Our present case further points out that CPM with minimal symptoms, could develop in normal pregnancy and could only be related to habitual salt-free diet.A previously healthy, normotensive, 38-year-old Greek female, gravida 1, 28 weeks pregnant, complained of right hemifacial paresthesias of increasing intensity over 10 days and was referred by her gynecologist for further evaluation. She had a 2-year history of salt-free diet, due to personal dietary habits, as well as no alcohol use. The neurological examination was normal, except for mild, right facial hypesthesia over the second trigeminal division. Extensive hematological and biochemical tests, including serum B12, folate, potassium, calcium, homocysteine, collagen, liver, kidney, venereal, viral, immunological disease, protein S and C, anticardiolipin antibodies, lupus anticoagulant and coagulation studies were either normal or unrevealing except for serum sodium level of 130 mmol/l (normal range 135-145 mmol/l). Brain MRI demonstrated a prominent hyperintensity in the central pons on T2 (Fig. 1a), FLAIR (Fig. 1b) and diffusion (Fig. 1c) weighted images (WI) and was compatible with CPM [1, 2]. The pontine lesion was not detected on T1WI and no contrast was given due to the pregnancy. Subsequently, CSF examination (cytochemistry, antibodies detection, electrophoresis) provided normal findings. She was only consulted to return to a ''normal salt'' diet and was discharged from the hospital.Two months later, after an uncomplicated delivery, the patient gave birth to a normal baby, the facial paresthesias had completely resolved, the serum sodium level was 142 mmol/l, nevertheless repeat MRI showed partial resolution of the central pontine hyperintensity on T2 (Fig. 2a), FLAIR (Fig. 2b) and diffusion WI (Fig. 2c). T1WI remained unrevealing, even after gadolinium infusion.Although there are mechanisms proposed for the pathogenesis of CPM [1], the exact pathophysiology remains unknown [1,2]. In low serum sodium situations water flowing freely across cell membranes, causes vasogenic brain edema [1, 2] and indeed early pathological changes in CPM typically show microscopic intramyelinic edema and not demyelination [4]. In correcting the hyponatremia, if the rate of rise in tonicity is faster than the rate at which organic osmoles can be synthesized and/or transported into the cells, the cells will shrink and brain dehydration results in injury to oligodendrocytes [1,2], with predilection of the lesion to the pons [1]. Nevertheless, there is still some controversy because CPM has been described in patients with normal serum sodium concentrat...

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Resolution of MRI Findings in Central Pontine Myelinosis Associated With Hypokalemia

Cited by 12 publications

References 9 publications

Eunatraemic Hypokalaemic Central Pontine Myelinolysis in an Alcoholic Lady With Bulimia

Eunatraemic Hypokalaemic Central Pontine Myelinolysis in an Alcoholic Lady With Bulimia

Wernicke′s encephalopathy following hyperemesis gravidarum

Salt-free diet and pregnancy-related central pontine myelinolysis: “To diet or not?”

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