eMedicine Specialties > Neurology > Neurotoxicology

Central Pontine Myelinolysis: Differential Diagnoses & Workup

Author: Christopher Luzzio, MD, Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison
Contributor Information and Disclosures

Updated: Aug 26, 2009

Differential Diagnoses

Alcohol (Ethanol) Related Neuropathy
Leptomeningeal Carcinomatosis
Brainstem Gliomas
Multiple Sclerosis
Cerebellar Hemorrhage
Subarachnoid Hemorrhage
Complex Partial Seizures
Uremic Encephalopathy
Diffuse Sclerosis
Intracranial Hemorrhage
Lacunar Syndromes

Other Problems to Be Considered

Brainstem hemorrhage
Cyclosporine neurotoxicity (liver transplant patients)
Brainstem syndromes

Workup

Laboratory Studies

  • Cerebral spinal fluid (CSF) probably is not necessary when the etiology and diagnosis are obvious.
  • CSF studies may demonstrate increased opening pressure, elevated protein, or mononuclear pleocytosis.

Imaging Studies

  • MRI or CT imaging of the brain stem may not reveal an obvious anatomic disturbance. A thorough neurologic exam therefore is indispensable.
  • MRI is the imaging modality of choice. Typically, T2-weighted MRI images demonstrate hyperintense or bright areas where demyelination has occurred caused by relatively increased water content in those regions.

    T2-weighted MRI scan of the brain demonstrating p...

    T2-weighted MRI scan of the brain demonstrating patchy areas of signal change within the pons that are consistent with demyelination or central pontine myelinolysis. Courtesy of Dr Andrew Waclawik, Department of Neurology, University of Wisconsin, Madison.

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    T2-weighted MRI scan of the brain demonstrating p...

    T2-weighted MRI scan of the brain demonstrating patchy areas of signal change within the pons that are consistent with demyelination or central pontine myelinolysis. Courtesy of Dr Andrew Waclawik, Department of Neurology, University of Wisconsin, Madison.

Other Tests

  • Electroencephalography in central pontine myelinolysis may demonstrate diffuse bihemispheric slowing.
  • Brainstem-evoked potentials may reveal abnormalities when neuroimaging is unrevealing.

Histologic Findings

Relative preservation of axons and surrounding neurons within areas of demyelination and an associated reduction in oligodendroglia is present.

More on Central Pontine Myelinolysis

Overview: Central Pontine Myelinolysis
Differential Diagnoses & Workup: Central Pontine Myelinolysis
Treatment & Medication: Central Pontine Myelinolysis
Follow-up: Central Pontine Myelinolysis
Multimedia: Central Pontine Myelinolysis
References
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References

  1. Adams RD, Victor M, Mancall EL. Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients. AMA Arch Neurol Psychiatry. Feb 1959;81(2):154-72. [Medline].

  2. Singh N, Yu VL, Gayowski T. Central nervous system lesions in adult liver transplant recipients: clinical review with implications for management. Medicine (Baltimore). Mar 1994;73(2):110-8. [Medline].

  3. DeWitt LD, Buonanno FS, Kistler JP, et al. Central pontine myelinolysis: demonstration by nuclear magnetic resonance. Neurology. May 1984;34(5):570-6. [Medline].

  4. Haspolat S, Duman O, Senol U, Yegin O. Extrapontine myelinolysis in infancy: report of a case. J Child Neurol. Nov 2004;19(11):913-5. [Medline].

  5. Karp BI, Laureno R. Pontine and extrapontine myelinolysis: a neurologic disorder following rapid correction of hyponatremia. Medicine (Baltimore). Nov 1993;72(6):359-73. [Medline].

  6. Laureno R, Karp BI. Myelinolysis after correction of hyponatremia. Ann Intern Med. Jan 1 1997;126(1):57-62. [Medline].

  7. Martin RJ. Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes. J Neurol Neurosurg Psychiatry. Sep 2004;75 Suppl 3:iii22-8. [Medline].

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Further Reading

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Keywords

central pontine myelinolysis, osmotic myelinolysis, CPM, hyponatremia, noninflammatory demyelination, stripping of the myelin sheath, alcoholism, liver disease, malnutrition

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Contributor Information and Disclosures

Author

Christopher Luzzio, MD, Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison
Christopher Luzzio, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Medical Editor

Howard A Crystal, MD, Professor, Departments of Neurology and Pathology, State University of New York Downstate; Consulting Staff, Department of Neurology, University Hospital and Kings County Hospital Center
Howard A Crystal, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association
Disclosure: Medivations Honoraria Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard J Caselli, MD, Professor, Department of Neurology, Mayo Medical School, Rochester, MN; Chair, Department of Neurology, Mayo Clinic of Scottsdale
Richard J Caselli, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Neurological Association, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Stephen A Berman, MD, PhD, Professor, Department of Internal Medicine, Section of Neurology, Dartmouth Medical School; Chief, Neurology Service, White River Junction Veterans Medical Center
Stephen A Berman, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

 
 
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