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Central Pontine Myelinolysis

Demyelination of the central pons (and sometimes extrapontine sites) caused mainly by overly rapid correction of chronic hyponatremia, leading to quadriparesis, dysarthria, and locked-in syndrome.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Nöroloji department. Book Appointment →

What is Central Pontine Myelinolysis?

Central pontine myelinolysis (CPM) is a non-inflammatory demyelinating disease of the central pons; together with extrapontine involvement (basal ganglia, thalamus, cerebellum) it is grouped as osmotic demyelination syndrome.

It develops most commonly after rapid correction of chronic hyponatremia, especially when sodium increases by more than 8 to 10 mmol/L in 24 hours; risk is higher in alcoholism, malnutrition, hypokalemia, liver disease, and post-transplant patients.

Diagnosis is supported by characteristic 'trident' or 'bat-wing' T2 hyperintensity in the central pons on brain MRI 1 to 2 weeks after the metabolic event; treatment is supportive, and prevention with carefully calibrated sodium correction is the cornerstone.

Symptoms

Initial improvement after correction of hyponatremia, followed by neurological deterioration days later
Progressive dysarthria and dysphagia
Quadriparesis and pseudobulbar features
Locked-in syndrome with preserved consciousness in severe cases
Movement disorders and behavioral changes with extrapontine involvement
Seizures, coma, and respiratory failure in advanced disease

Risk Factors

Chronic alcoholism and malnutrition
Severe chronic hyponatremia (Na <120 mmol/L)
Hypokalemia and hypomagnesemia
Liver disease, especially after transplantation
Burn injuries, hyperemesis gravidarum, and SIADH

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • New neurological deterioration after rapid correction of hyponatremia
  • Quadriparesis or bulbar symptoms in patients with electrolyte disturbance
  • Patients with chronic alcoholism and severe hyponatremia
  • Need for monitored, slow sodium correction in chronic hyponatremia

Treatment Methods

01
Strict prevention with sodium correction limited to 8 to 10 mmol/L in 24 hours and 18 mmol/L in 48 hours in chronic hyponatremia
02
Re-lowering serum sodium with hypotonic fluids and desmopressin if overcorrection has occurred
03
Supportive treatment with intensive care, mechanical ventilation, and nutritional support as needed
04
Multidisciplinary rehabilitation including physical, occupational, and speech therapy
05
Treatment of underlying alcoholism, malnutrition, and electrolyte disturbances and prognostic counseling for the patient and family

Which Department to Visit?

You can visit our Nöroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.