Central pontine myelinolysis (patient information)

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Synonyms and Keywords: Osmotic demyelination syndrome

Overview
Central pontine myelinolysis is brain cell dysfunction caused by the destruction of the layer (myelin sheath) covering nerve cells in the brainstem (pons).

What are the symptoms of Central pontine myelinolysis?

 * Confusion, delirium
 * Balance problems
 * Difficulty swallowing
 * Hallucinations
 * Reduced alertness, drowsiness or sleepiness, lethargy, poor responses
 * Speech changes, poor enunciation
 * Tremor
 * Weakness in the face, arms, or legs, usually affecting both sides of the body

What causes Central pontine myelinolysis?

 * The destruction of the myelin sheath that covers nerve cells prevents signals from being properly transmitted in the nerve. This decreases the nerve's ability to communicate with other cells.


 * The most common cause of central pontine myelinolysis is a quick rise in the body's sodium levels. This most often occurs when someone is being treated for low blood levels of sodium (hyponatremia) and the levels rise too fast. It also can occasionally occur when high levels of sodium in the body (hypernatremia) are corrected too quickly.


 * This condition does not occur on its own. It is a complication of treatment for other conditions or from the other conditions themselves.

Who is at highest risk?
Risks include:
 * Alcoholism
 * Liver disease
 * Malnutrition from serious illnesses

When to seek urgent medical care?
There is no real guideline on when to seek medical attention, because this condition is rare in the general community.

Diagnosis

 * An examination may show:
 * Abnormal reflexes
 * Confusion
 * Involvement of all four arms and legs (spastic quadriplegia)
 * Weakness of the face, arms, and legs (upper motor neuron syndromes)


 * A head MRI scan may reveal a problem in the brainstem (pons). This is the main diagnostic test.


 * Other tests may include:
 * Blood sodium levels and other blood tests
 * Brainstem auditory evoked response (BAER)

Treatment options

 * This is an emergency disorder. You will need to go to a hospital for diagnosis and treatment. However, most people with this condition are already in the hospital for another condition.


 * There is no known cure for central pontine myelinolysis. Treatment is focused on relieving symptoms.


 * Physical therapy may help maintain muscle strength, mobility, and function in weakened arms and legs.

Where to find medical care for Central pontine myelinolysis?
Directions to Hospitals Treating Central pontine myelinolysis

What to expect (Outlook/Prognosis)?

 * The nerve damage caused by central pontine myelinolysis is usually long-lasting.


 * The disorder can cause serious long-term (chronic) disability.

Possible complications

 * Decreased ability to interact with others
 * Decreased ability to work or care for self
 * Inability to move, other than to blink eyes ("locked in" syndrome)
 * Permanent nervous system damage

Prevention

 * Gradual, controlled treatment of low sodium levels may reduce the risk of nerve damage in the pons.


 * Being aware of how some medications can change sodium levels can prevent these levels from changing too quickly.

Source
http://www.nlm.nih.gov/medlineplus/ency/article/000775.htm