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What is Central Pontine Myelinolysis?

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  • Written By: Mary McMahon
  • Edited By: O. Wallace
  • Last Modified Date: 24 August 2016
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Central pontine myelinolysis is a serious neurological condition caused by damage to the nerves in the area of the brainstem known as the pons. In patients with this condition, the myelin sheath which protects the nerves is damaged, interfering with their ability to signal to each other. This condition can be fatal or cause long term disability. Most patients experience at least some lingering effects as a result of central pontine myelinolysis.

This condition is caused by disease processes or treatments designed to address a disease. The most common cause of central pontine myelinolysis is an elevation of sodium levels which is too rapid. When people develop low sodium, a condition known as hyponatremia, doctors infuse them with sodium to restore the balance of salts in the body. If this is done too fast, especially if the low sodium levels persisted for two days or more, the patient can have central pontine myelinolysis as a result. Likewise, bringing sodium levels down too fast can cause damage to the myelin in the pons.

It is believed that this condition happens when the rapid movement of fluids in and out of the myelin caused by changes in sodium levels damages the myelin. The exact mechanics of the damage are not well understood. People at risk for central pontine myelinolysis include burn victims, people suffering from dehydration, alcoholics, bulimics, and anorexics. All of these individuals tend to have imbalanced salt levels and sometimes treatment causes rapid changes.

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Signs that someone may have central pontine myelinolysis include slurred speech, blurred vision, confusion, muscle weakness, muscle paralysis, constipation, difficulty swallowing, and loss of consciousness. Some patients experience a condition known as locked in state, in which they appear to be unresponsive but are actually fully awake and aware. Others may lapse into a coma or die as a result of the damage to their myelin.

Magnetic resonance imaging can be used to identify the tell-tale signs of damage which indicate that someone has central pontine myelinolysis. This condition has no cure, with treatment focusing on supportive care. This can include physical therapy, putting the patient on a ventilator to help the patient breathe, developing alternative modes of communication if the patient cannot speak, and providing patients with supplementary nutrition if they cannot eat. Some patients may retain functionality and develop more during recovery from this brain injury, while others may require permanent personal assistance or hospitalization.

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