CENTRAL PONTINE MYELINOLYSIS

SYMPTOMS

The symptoms of central pontine myelinolysis can vary depending on the extent and severity of brain damage. Common symptoms may include:

• Muscle weakness, particularly in the limbs
• Difficulty speaking or swallowing
• Impaired coordination and balance (ataxia)
• Changes in vision, such as double vision or blurry vision
• Dysarthria (difficulty with speech articulation)
• Altered mental status, ranging from confusion to coma
• Seizures (less common)

DIAGNOSIS

Diagnosing central pontine myelinolysis typically involves a combination of clinical evaluation, imaging studies, and laboratory tests. Key diagnostic steps may include:

• Brain imaging: Magnetic resonance imaging (MRI) of the brain is the most sensitive imaging modality for detecting myelin damage in the pons. MRI may reveal characteristic changes, such as hyperintensity on T2-weighted images and hypointensity on T1-weighted images, in the central part of the pons.
• Laboratory tests: Serum sodium levels and other electrolyte levels are measured to assess for hyponatremia and other metabolic abnormalities.
• Neurological examination: Assessment of muscle strength, reflexes, coordination, and mental status can help identify neurological deficits associated with CPM.

TREATMENT

Treatment of central pontine myelinolysis focuses on supportive care and preventing further neurological damage. There is no specific treatment to reverse myelin destruction once it has occurred. Management strategies may include:

• Correction of electrolyte imbalances: If hyponatremia or other electrolyte abnormalities are present, gradual correction under close monitoring is recommended to prevent osmotic shifts and further brain damage.
• Symptomatic treatment: Addressing specific symptoms such as muscle weakness, dysphagia, or dysarthria may involve physical therapy, speech therapy, and occupational therapy to improve functional outcomes.
• Prevention of complications: Monitoring for complications such as respiratory failure, aspiration pneumonia, or seizures and providing appropriate supportive care as needed.
• Long-term rehabilitation: Depending on the extent of neurological deficits, individuals with CPM may benefit from intensive rehabilitation programs aimed at improving motor function, speech, and activities of daily living.