What is Extrapontine Myelinolysis?

Extrapontine myelinolysis (EPM) is one of the complications occurring secondary to rapid correction of hyponatremia, and is, along with central pontine myelinolysis encompassed by the more recent term osmotic demyelination syndrome.

Is central pontine Myelinolysis reversible?

Similarly to prior CPM case reports, this patient significantly improved following reinduction of hyponatremia, methylprednisolone, and/or plasmapharesis. This report demonstrates that CPM is potentially reversible when quickly recognized and therapeutic interventions are initiated rapidly.

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].

What is osmotic demyelination syndrome?

Osmotic demyelination syndrome (ODS) is brain cell dysfunction. It is caused by the destruction of the layer (myelin sheath) covering nerve cells in the middle of the brainstem (pons).

What is the relation between central pontine and extrapontine myelinolysis?

Relative proportions of central pontine myelinolysis (CPM), extrapontine myelinolysis (EPM), and CPM with EPM. While no significant advance on the description of the clinical features of CPM has been made since the original report, the manifestations of EPM continue to attract publication, especially in the movement disorder literature.

How can extrapontine myelinolysis make a complete recovery?

Extrapontine myelinolysis could make a complete recovery with symptomatic support alone. During hyponatraemia correction, rapid osmotic shifts of fluid that cause hypernatremia, causes myelinolysis rather than absolute serum sodium level.

Can a MRI show extrapontine myelinolysis ( EPM )?

MRI changes were suggestive of Extrapontine myelinolysis (EPM). This case is at variance with four previous cases reported in the medical literature in that the patient made a full clinical recovery and the MR changes resolved with symptomatic support alone. Extrapontine myelinolysis could make a complete recovery with symptomatic support alone.

When to diagnose central pontine myelinolysis?

To summarise: “…whenever a patient who is gravely ill with alcoholism and malnutrition or a systemic medical disease develops confusion, quadriplegia, pseudobulbar palsy, and pseudo coma (‘locked-in syndrome’) over a period of several days, one is justified in making a diagnosis of central pontine myelinolysis’. 2