Central pontine myelinolysis

Central pontine myelinolysis (CPM), a neurologic disorder caused most frequ ently by rapid correction of hyponatremia, is characterized by demyelinatio n that affects the central portion of the base of the pens. There are no in flammatory changes, and blood vessels are normal. Clinical features usually reflect damage to the descending motor tracts and include spastic tetrapar esis, pseudobulbar paralysis, and the locked-in syndrome. Magnetic resonanc e imaging of the brain, the imaging procedure of choice, shows an area of p rolonged T1 and T2 relaxation in the central pens, which may have a charact eristic shape. Recovery varies, ranging from no improvement to substantial improvement. To avoid CPM correction of serum sodium in patients with hypon atremia should not exceed 12 mEq/24 h. We describe a case of CPM in a hypon atremic patient who presented with a cerebellar syndrome with no pyramidal tract involvement and in whom the rate of correction of serum sodium was wi thin the recommended limits.