Therapeutic plasma exchange (TPE) has been reported as a possible treatment for osmotic demyelination syndrome – central pontine myelinolysis (ODS-CPM), a degeneration of myelin within the central nervous system related to rapid hyponatremia correction, which though uncommon, has significant morbidity, and has no established specific treatment. We present our experience with a 41-year-old male with chronic kidney disease, maintained on steroids, who presented with lethargy and behavioral changes. Initial metabolic panel showed severe hyponatremia (Na 109 mEq/L). Despite cautious sodium correction, the patient’s sensorium decreased further and was intubated. Involuntary movements of the left face and arm were later seen. T2/FLAIR hyperintensities in the brainstem and thalami affirmed the diagnosis of ODS. A total of nine cycles (one cycle every two to three days) of TPE were completed. The patient was discharged with improved sensorium, from E2VxM4 to E4VxM6, and with no indication for hemodialysis due to improved creatinine. One year later, the patient has no remaining neurologic deficits. Our experience supports other case reports that TPE is a viable therapy for ODS-CPM.
Myelinolysis, Central Pontine ; Renal Insufficiency, Chronic

Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are well recognized syndromes related to the rapid correction of hyponatremia. Cognitive dysfunction and neuropsychological findings, however, have seldom been reported. We present a case of EPM without CPM and report the neuropsychological findings. Neuropsychological testing showed severe impairment of attention, verbal and visual memory, visuospatial functioning, and frontal/executive functioning. Language and language-related functions were normal except for naming. Follow-up neuropsychological testing at 4 months later showed slightly less impairment than the first assessment.
Follow-Up Studies* ; Hyponatremia ; Memory ; Myelinolysis, Central Pontine* ; Neuropsychological Tests

Neurological complications occur frequently in patients undergoing liver transplantation. We report a case of multi-ple neurologic complications including central pontine and extrapontine myelinolysis, seizure, and mutism after liver transplantation. Though the cause would be obscure and multifactorial, the hyponatremia with its rapid correction dur-ing operation and the side effects of the immunosuppressant would be the most probable causes in this case.
Humans ; Hyponatremia ; Liver Transplantation* ; Liver* ; Mutism ; Myelinolysis, Central Pontine ; Seizures

No abstract available.
Female ; Hyperemesis Gravidarum* ; Hypokalemia* ; Myelinolysis, Central Pontine* ; Pregnancy

OBJECTIVE: Severe hyponatremia is rare but constitute a true medical emergency since it has deleterious effects on the central nervous system. The etiology and clinical presentation of severe hyponatremia are diverse and nonspecific, furthermore, the optimal therapeutic approach is debatable at the present time. Therefore, the purpose of this study is to analyze the clinical manifestations of severe hyponatremic patients and to assess the outcomes with special reference to the rate of its correction. METHODS: This retrospective study analyzed the clinical course of 27 consecutive patients(pts) at a single medical center who presented with neurologic hyponatremic symptoms as well as a serum sodium (Na) concentration less than 125mEq/L. RESULTS: Of 27 hyponatremic patients, male to female ratio was almost equal, 13 to 14, and mean age was 67.1 years. The most common cause of hyponatremia was SIADH(11 pts, 40.7%), followed by hypovolemia(11 pts, 37.1%), and edema(4 pts, 14.8%). Hyponatremic neurologic symptoms included lethargy(33.3%), confusion with drowsy mentality (33.3%), dizziness(18.6%), and semicoma(7.4%), respectively. The rate of increase to a serum Na concentration to 125mEq/L during correction of hyponatremic averaged 0.56+/-0.49mEq/L/hr while the maximum increase in serum Na concentration during any period of the hospital course, mostly initial phase, averaged 0.69+/-0.63mEq/L/hr in all 27 pts, of whom 18 pts(66.7%) was less than 0.5mEq/L/hr, 3 pts from 0.5 to 1.0mEq/L/hr(11.1%), and 6 pts more than 1.0mEq/L/hr(22.2%). All 27 pts but one recovered from neurologic symptoms due to hyponatremia without neurologic sequale. Extrapontine myelinolysis with locked in condition was developed during the course of treating hyponatremia in a pts, of whom serum Na concentration before treatment was the lowest(92mEq/L) with the rate of correction to 125mEq/L by 1.26mEq/L/hr and the initial rate of correction within the first 6 hour by 3.17mEq/L/hr. No one died of hyponatremia itself during the course of its treatment but 3 deaths of 27 pts were attributed to the pts' severe underlying diseases. CONCLUSION: Surprisingly, these data revealed the relatively benign course of severe symptomatic hyponatremia. However, in assessing the outcome of severe symptomatic hyponatremia, the initial degree of hyponatremia as well as the rate of correction during its treatment, particularly the initial rate of correction within the first 6 hour, would be considered.
Central Nervous System ; Emergencies ; Female ; Humans ; Hyponatremia ; Male ; Myelinolysis, Central Pontine ; Neurologic Manifestations* ; Retrospective Studies ; Sodium

Central pontine myelinolysis occurs inconsistently as a complication of severe and prolonged hyponatremia, particularly when corrected too rapidly. This condition is a concentrated, frequently symmetric, noninflammatory demyelination within the central basis pontis. We describe a head injury patient who developed central pontine and extrapontine myelinolysis following a gradual correction of hyponatremia. More attention should be paid to correcting hyponatremia combined with hypokalemia in patients who have a history of alcoholism.
Alcoholism ; Brain Injuries* ; Craniocerebral Trauma ; Demyelinating Diseases ; Humans ; Hypokalemia ; Hyponatremia* ; Myelinolysis, Central Pontine*

No abstract available.
Cadaver ; Humans ; Hypernatremia ; Liver ; Liver Transplantation ; Myelinolysis, Central Pontine ; Tissue Donors

Osmotic myelinolysis is a distinctive clinical syndrome with a characteristic "bat wing" MRI lesion in the central pons, which is also called central pontine myelinolysis (CPM). However, demyelinating lesions are not only limited to the central pons, but also may be involved in the extrapontine regions including the basal ganglia, thalamus, and cerebellum (extrapontine myelinolysis; EPM). We report an atypical case of osmotic myelinolysis confined to the pyramidal tract from the precentral gyrus to the central pons via the corona radiata and internal capsule in a MR image.
Basal Ganglia ; Cerebellum ; Internal Capsule ; Magnetic Resonance Imaging ; Myelinolysis, Central Pontine ; Pons* ; Pyramidal Tracts* ; Thalamus

We report 3 cases of central pontine myelinolysis (CPM), one is 35-year-old woman with Seehan's syndrome and the others are 45-yearold and 55-year-old men with chronic alcohol ism, who are diagnosed by clinical symptoms of slowly progressive quadriplegia and pseudobulbar palsy, and findings of computed tomography and magnetic resonance imaging.
Adult ; Female ; Humans ; Magnetic Resonance Imaging* ; Male ; Middle Aged ; Myelinolysis, Central Pontine* ; Pseudobulbar Palsy ; Quadriplegia

Hyponatremia is common in end stage liver disease and central pontine myelinolysis (CPM) can occur after the rapid correction of hyponatremia. The blood sodium concentration can increase rapidly during the perioperative period of liver transplantation due to the administration of sodium-containing fluids and blood products. We experienced 5 cases of CPM after liver transplantation. Major changes in the blood sodium concentrations occurred during surgery in the first 3 cases while these changes occurred after surgery in the last 2 cases. We reviewed the blood sodium concentrations of these 5 patients and speculated on the correlation of CPM with a rapid increase in the blood sodium concentration.
End Stage Liver Disease ; Humans ; Hyponatremia ; Liver Transplantation* ; Liver* ; Myelinolysis, Central Pontine* ; Perioperative Period ; Sodium