Central pontine myelinolysis

Central pontine myelinolysis (CPM) was initially associated with alcoholism . Subsequently other factors, including rapid reversal of hyponatraemia and extreme serum hypoosmolality associated with severe burns, have been ident ified as other important factors in its pathogenesis. Extra-pontine lesions have also been described. CPM may be found at autopsy, either having been overlooked during life or as an incidental finding. Its precise incidence i s not known but the ability to diagnose it during life has been helped by m odern neuroimaging, particularly magnetic resonance imaging (MRI) of the br ain stem. In the past the prognosis for CPM was thought to be invariably fa tal. It is clear now that with the greater general awareness of the disorde r and the ability to diagnose it during life that some degree of recovery i s possible. However, the number who do recover and the degree of recovery i s not known. We report a 40-year-old man who developed CPM presenting with quadriparesis and inability to speak and swallow. There were risk factors f or CPM and the diagnosis was confirmed by MRI scanning. He made a complete recovery although he remains ataxic. We are reporting this case as we belie ve it is important to make clinicians aware of the potential for recovery o f CPM. While no specific treatment has been shown to influence the degree a nd rate of recovery of the demyelination, the fact that the quadriplegia an d bulbar paralysis can recover fully is of considerable importance. In part icular, it means that when the diagnosis is made, complete and vigorous nur sing and medical care is warranted. Journal of Clinical Neuroscience (1999) 6(2), 155-157 (C) 1999 Harcourt Brace & Co. Ltd.