Can hyponatremia cause pontine Myelinolysis?
Central pontine myelinolysis is a rare neurologic condition most frequently caused by the rapid correction of hyponatremia.
What is Myelinolysis hyponatremia?
Definition. Central pontine myelinolysis (CPM) is a neurological disorder that most frequently occurs after too rapid medical correction of sodium deficiency (hyponatremia). The rapid rise in sodium concentration is accompanied by the movement of small molecules and pulls water from brain cells.
Can hypernatremia cause central pontine Myelinolysis?
Central pontine myelinolysis reportedly occurs occasionally in patients who are treated for hypernatremia. Central pontine myelinolysis may complicate liver transplantation surgery.
How does sodium cause osmotic demyelination syndrome?
The most common cause of ODS is a quick change in the body’s sodium levels. This most often occurs when someone is being treated for low blood sodium (hyponatremia) and the sodium is replaced too fast. Sometimes, it occurs when a high level of sodium in the body (hypernatremia) is corrected too quickly.
What is Myelinolysis?
“Myelinolysis” means that the myelin — the covering that protects nerve cells, including the pontine nerve cells — is being destroyed. The destruction of myelin is generally not spontaneous. CPM usually happens as a result of another illness or medical condition.
What are the symptoms of Pontine Myelinolysis?
Symptoms may include any of the following:
- Confusion, delirium, hallucinations.
- Balance problems, tremor.
- Problem swallowing.
- Reduced alertness, drowsiness or sleepiness, lethargy, poor responses.
- Slurred speech.
- Weakness in the face, arms, or legs, usually affecting both sides of the body.
What are symptoms of central pontine Myelinolysis?
What is the most dreaded complication in rapid correction of hyponatremia?
But new evidence shows that when patients with hyponatremia get admitted to the hospital, their impatient treatment teams often correct sodium levels too quickly, increasing the risk for dangerous complications. Too-rapid correction of sodium can cause osmotic demyelination syndrome (ODS), a form of brain damage.
Why does hyponatremia cause cerebral edema?
When hyponatremia occurs, the resulting decrease in plasma osmolality (with the exception of the rare cases of non-hypoosmotic hyponatremia) causes water movement into the brain in response to the osmotic gradient, thus causing cerebral edema [7,8] (Figure 1b).
Can you recover from central pontine Myelinolysis?
CPM was originally believed to have a mortality rate over 50 percent , but early diagnosis has improved the outlook. Although some people still die as a result of the brain damage sustained, many people with CPM are able to recover. Recent research puts the survival rate at around 94 percent .
What happens if you correct hyponatremia too quickly?
Does osmotic demyelination syndrome follow rapid correction of hyponatremia?
Background: Osmotic demyelination syndrome commonly follows rapid correction of hyponatremia. Although pons is a common location, extrapontine locations, such as striatum and thalamus, have been reported.
Is hypopituitarism an underrecognized cause of hyponatremia?
Hypopituitarism is an underrecognized cause of hyponatremia. When treating a patient with hyponatremia, knowing the pituitary function status is a prerequisite for the physician to prevent osmotic demyelination syndrome. Keywords: Extrapontine myelinolysis; Hyponatremia; Hypopituitarism; Osmotic demyelination; Parkinsonism; Pituitary adenoma.
How is hyponatremia diagnosed?
Hyponatremia was diagnosed following a bout of diarrhea, which was corrected with hypertonic saline. Magnetic resonance imaging of the brain showed a giant pituitary adenoma. Hyperintensities on T2-weighted imaging were also seen at the level of pons and bilateral striatum. Central pontine myelinolysis and extrapontine myelinolysis were diagnosed.
What is the prognosis of central pontine myelinolysis (ODS)?
Favorable prognosis is possible in patients of ODS, even with severe neurological presentation. Further research is required to confirm the differences found in liver transplant recipients. Keywords: central pontine myelinolysis; extrapontine myelinolysis; osmotic demyelination.
