What is Extrapontine Myelinolysis?
Central pontine myelinolysis (CPM) is a demyelinating disorder characterized by the loss of myelin in the center of the basis pontis, usually caused by rapid correction of chronic hyponatremia. On rare occasions, demyelination occurs outside the pons and is termed extrapontine myelinolysis (EPM).
What is osmotic Myelinolysis?
Osmotic myelinolysis (OM) is an acute, non-inflammatory demyelinating disease that can develop following rapid correction of hyponatremia from any cause.
What causes central pontine myelinolysis?
Central pontine myelinolysis (CPM) is a neurological disorder that most frequently occurs after too rapid medical correction of sodium deficiency (hyponatremia). The rapid rise in sodium concentration is accompanied by the movement of small molecules and pulls water from brain cells.
How do you manage osmotic demyelination syndrome?
Apart from supportive care, there is no proven treatment for established ODS. Re-lowering of sodium using 5% dextrose and desmopressin have shown benefit in treating ODS in animal models, but data in humans is limited to case reports and case series [5, 15].
What condition can be Iatrogenically caused by reversing hyponatremia too rapidly?
Too-rapid correction of sodium can cause osmotic demyelination syndrome (ODS), a form of brain damage.
What is rapid correction of hyponatremia?
Rapid correction is defined as correction by >12 mEq/L in 24 h or >18 mEq/L in 48 h. In patients with chronic hyponatremia, rapid correction was significantly more likely to result in post-therapeutic complications than slow correction (p < 0.01).
How do you fix overcorrection hyponatremia?
Excessive correction usually results from the unexpected emergence of a water diuresis after resolution of the cause of water retention. The concurrent administration of desmopressin and 5 % dextrose in water can be given to cautiously re-lower the serum sodium concentration when therapeutic limits have been exceeded.
Is central pontine myelinolysis progressive?
Central pontine myelinolysis (CPM) was originally considered to be the result of excessively rapid correction of slowly progressive hyponatremia in patients with chronic medical conditions, such as chronic alcoholism, malnutrition, and malignancy [1,2].
Is pons and pontine the same?
The pons is a major division of the brainstem. It is found above the medulla and below the midbrain, and is anterior to (in front of) the cerebellum. The pontine tegmentum includes the tissue between the basal pons and the fourth ventricle; the pons makes up the floor of the fourth ventricle.
Can hyponatremia cause pontine Myelinolysis?
Central pontine myelinolysis is a rare neurologic condition most frequently caused by the rapid correction of hyponatremia.
How can central pontine myelinolysis be prevented?
Explain the prevention of central pontine myelinolysis by adjusting the rate at which sodium should be corrected. The current recommendations are a range from 8-12 mEq/L per 24 hours.
How does osmotic demyelination syndrome happen?
The most common cause of ODS is a quick change in the body’s sodium levels. This most often occurs when someone is being treated for low blood sodium (hyponatremia) and the sodium is replaced too fast. Sometimes, it occurs when a high level of sodium in the body (hypernatremia) is corrected too quickly.