Central pontine myelinolysis
10,413views
00:00 / 00:00
Videos
Notes
Central pontine myelinolysis
Nervous system
Central nervous system disorders
Spina bifida
Chiari malformation
Dandy-Walker malformation
Syringomyelia
Tethered spinal cord syndrome
Aqueductal stenosis
Septo-optic dysplasia
Cerebral palsy
Spinocerebellar ataxia (NORD)
Transient ischemic attack
Ischemic stroke
Intracerebral hemorrhage
Epidural hematoma
Subdural hematoma
Subarachnoid hemorrhage
Saccular aneurysm
Arteriovenous malformation
Broca aphasia
Wernicke aphasia
Wernicke-Korsakoff syndrome
Kluver-Bucy syndrome
Concussion and traumatic brain injury
Shaken baby syndrome
Epilepsy
Febrile seizure
Early infantile epileptic encephalopathy (NORD)
Tension headache
Cluster headache
Migraine
Idiopathic intracranial hypertension
Trigeminal neuralgia
Cavernous sinus thrombosis
Alzheimer disease
Vascular dementia
Frontotemporal dementia
Lewy body dementia
Creutzfeldt-Jakob disease
Normal pressure hydrocephalus
Torticollis
Essential tremor
Restless legs syndrome
Parkinson disease
Huntington disease
Opsoclonus myoclonus syndrome (NORD)
Multiple sclerosis
Central pontine myelinolysis
Acute disseminated encephalomyelitis
Transverse myelitis
JC virus (Progressive multifocal leukoencephalopathy)
Adult brain tumors
Acoustic neuroma (schwannoma)
Pituitary adenoma
Pediatric brain tumors
Brain herniation
Brown-Sequard Syndrome
Cauda equina syndrome
Treponema pallidum (Syphilis)
Vitamin B12 deficiency
Syringomyelia
Friedreich ataxia
Neurogenic bladder
Meningitis
Neonatal meningitis
Encephalitis
Brain abscess
Epidural abscess
Cavernous sinus thrombosis
Creutzfeldt-Jakob disease
Central and peripheral nervous system disorders
Sturge-Weber syndrome
Tuberous sclerosis
Neurofibromatosis
von Hippel-Lindau disease
Amyotrophic lateral sclerosis
Peripheral nervous system disorders
Spinal muscular atrophy
Poliovirus
Guillain-Barre syndrome
Charcot-Marie-Tooth disease
Trigeminal neuralgia
Bell palsy
Winged scapula
Thoracic outlet syndrome
Carpal tunnel syndrome
Ulnar claw
Erb-Duchenne palsy
Klumpke paralysis
Sciatica
Myasthenia gravis
Lambert-Eaton myasthenic syndrome
Autonomic nervous system disorders
Orthostatic hypotension
Horner syndrome
Nervous system pathology review
Congenital neurological disorders: Pathology review
Headaches: Pathology review
Seizures: Pathology review
Cerebral vascular disease: Pathology review
Traumatic brain injury: Pathology review
Spinal cord disorders: Pathology review
Dementia: Pathology review
Central nervous system infections: Pathology review
Movement disorders: Pathology review
Neuromuscular junction disorders: Pathology review
Demyelinating disorders: Pathology review
Adult brain tumors: Pathology review
Pediatric brain tumors: Pathology review
Neurocutaneous disorders: Pathology review
Assessments
Central pontine myelinolysis
Flashcards
0 / 8 complete
USMLE® Step 1 questions
0 / 1 complete
High Yield Notes
8 pages
Flashcards
Central pontine myelinolysis
of complete
Questions
USMLE® Step 1 style questions USMLE
of complete
| Laboratory value | Result |
| Sodium | 108 mEq/L |
| Potassium | 4.2 mEq/L |
| Chloride | 95 mEq/L |
| Creatinine | 0.9 mg/dL |
| Albumin | 3.2 g/dL |
The patient is started on hypertonic saline. On the second day of treatment, the partner notices the patient is unable to move, but she is able to blink in response to questions. Which of the following is the most likely location of the brain lesion in this patient?
Image reproduced from Wikimedia Commons
Memory Anchors and Partner Content
External References
First Aid
2022
2021
2020
2019
2018
2017
2016
Central pontine myelinolysis p. 542
Diplopia
osmotic demyelination syndrome p. 542
Dysarthria p. 533
osmotic demyelination syndrome p. 542
Dysphagia
osmotic demyelination syndrome p. 542
“Locked-in” syndrome
osmotic demyelination syndrome p. 542
Osmotic demyelination syndrome p. 542
SIADH and p. 351
External Links
Transcript
Contributors
Samantha McBundy, MFA, CMI
Gil McIntire
Tanner Marshall, MS
In central pontine myelinolysis, pontine refers to the pons of the brainstem, myelin refers to the fatty layer of insulation that wraps around neurons, and -lysis refers to destruction.
So, central pontine myelinolysis is the destruction of the myelin sheath around nerve cells that are in the pons.
The main cause of destruction is rapid osmotic changes, meaning that a lot of water leaves the cells, and dries them out, causing them to die.
So the other name for central pontine myelinolysis is osmotic demyelination syndrome.
Taking a look at the brain, the pons is part of the brainstem and it’s nestled between the midbrain and the medulla oblongata.
The pons itself has control centers that help manage the respiration rate and the depth of breathing while we’re awake and when we sleep. So if you try to take a deep breath right now - that’s your pons in action!
Neuron clusters or nuclei for cranial nerves V: trigeminal, VI: abducens, VII: facial, and VIII: vestibulocochlear are also housed in the pons.
Cranial nerve V allows you to feel things on your face and controls the muscles that help you chew, bite, and swallow.
Cranial nerve VI allows your eyes to move side to side.
Cranial nerve VII helps with facial expressions - like making a weird face, and cranial nerve VIII helps with hearing.
All of these nerves are made up of lots of individual neurons which capture signals from their dendrites, and pass those signals along through their axons.
Summary
Central pontine myelinolysis (CPM) is a neurological disorder caused by the rapid correction of hyponatremia. CPM is a demyelinating disease that damages the insulation around nerve fibers (called myelin). This damage disrupts the conduction of nerve impulses, leading to neurologic deficits.
Symptoms of CPM include muscle weakness, difficulty swallowing, and problems with speech, vision, and balance. These symptoms often occur suddenly and progress rapidly. Death from respiratory failure can occur within days or weeks of onset.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "Central Pontine and Extrapontine Myelinolysis After Alcohol Withdrawal: Fig. 1" Alcohol and Alcoholism (2008)
- "Axonal damage: a key predictor of outcome in human CNS diseases" Brain (2003)
- "Clinical practice guideline on diagnosis and treatment of hyponatraemia" European Journal of Endocrinology (2014)
Copyright © 2023 Elsevier, except certain content provided by third parties
Cookies are used by this site.
USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.
