ISCHEMIC AND HEMORRHAGIC NECROSIS OF THE PONS WITH ANATOMICAL LOCATION SIMILAR TO THAT OF CENTRAL PONTINE MYELINOLYSIS IN A CHRONIC-ALCOHOLIC PATIENT

An autopsied case of recent ischemic and hemorrhagic necrosis of the p ons is reported, in which the anatomical site of the lesion is similar to that observed in central pontine myelinolysis. The patient, a 46-y ear-old woman, was a chronic alcoholic who had been treated with large quantities of physiological saline and glucose solution at 5% during a period of nine days before death. On the fifth day of treatment she developed hypernatremia, which persisted for three days. From hypergly cemia on the day of admission, her serum glucose levels subsequently d ropped to normal values and then rose again on the day of death. Exami nation of the brain revealed recent ischemic and hemorrhagic necrosis affecting the central portion of the upper two thirds of the pontine b asis, in triangular, bilaterally symmetrical pattern, and extending in to the tegmentum. There was no evidence of demyelination or degradatio n products of the myelin. No vascular alterations or thrombi were iden tified in the pontine vessels surrounding the lesion. The differential diagnosis of pontine infarct, central pontine myelinolysis, and Duret 's hemorrhage is discussed. In analysing the possible etiology and pat hogenesis of the lesion, it is suggested that osmotic vascular injurie s induced by fluctuating levels of serum sodium and glucose may lead t o edema and demyelination similar to that observed in central pontine myelinolysis and, rarely, to necrosis and hemorrhage, as in the presen t case.