From the Research
Central pontine myelinolysis (CPM) typically presents with a biphasic clinical course, initially showing improvement from underlying conditions like hyponatremia, followed by neurological deterioration 2-6 days after rapid sodium correction, with common manifestations including altered mental status, dysarthria, dysphagia, and quadriparesis, as reported in a case study published in 2021 1. The clinical manifestations of CPM can vary widely, ranging from mild symptoms to life-threatening complications. Some patients may develop pseudobulbar palsy with emotional lability and "locked-in syndrome" where they remain conscious but cannot move or communicate except through eye movements. Seizures, behavioral changes, and movement disorders like parkinsonism or dystonia may also occur.
Key Clinical Features
- Altered mental status, ranging from confusion to coma
- Dysarthria and dysphagia
- Quadriparesis
- Pseudobulbar palsy with emotional lability
- "Locked-in syndrome"
- Seizures, behavioral changes, and movement disorders These manifestations result from demyelination in the central pons due to osmotic stress on oligodendrocytes, typically triggered by rapid correction of chronic hyponatremia (>10-12 mEq/L/24h), as noted in a study published in 2017 2.
Prevention and Management
Prevention is crucial by correcting sodium levels slowly (<8 mEq/L/24h), especially in chronically hyponatremic patients with risk factors like alcoholism, malnutrition, liver disease, or prolonged diuretic use. A study published in 1996 3 highlighted the importance of magnetic resonance imaging (MRI) in diagnosing CPM, as it is more sensitive than computed tomography (CT).
Diagnosis and Prognosis
The diagnosis of CPM can be challenging, and the prognosis can vary depending on the severity of the condition. A study published in 2010 4 presented two cases of CPM with different etiologies, clinical features, and courses of the disease, highlighting the variability of the condition. In summary, CPM is a serious condition that requires prompt recognition and management to prevent long-term neurological damage. The clinical manifestations of CPM can be severe and debilitating, emphasizing the need for careful correction of sodium levels and close monitoring of patients at risk, as reported in a case study published in 2021 1.