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VOLUME 26 , ISSUE 9 ( September, 2022 ) > List of Articles


Central Pontine Myelinolysis: A Case Report

Richa Tiwari, Anju Kumari

Keywords : Central pontine myelinolysis, Chronic alcoholic, Hyponatremia

Citation Information : Tiwari R, Kumari A. Central Pontine Myelinolysis: A Case Report. Indian J Crit Care Med 2022; 26 (9):1049-1051.

DOI: 10.5005/jp-journals-10071-24311

License: CC BY-NC 4.0

Published Online: 31-08-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Central pontine myelinolysis (CPM) classically occurs due to rapid rise in serum osmolarity. Most cases have been associated with a history of chronic alcohol abuse, malnutrition, diuretic abuse, and hyponatremia. The pathological process of CPM starts in the central pons near median raphe and spreads out “like a brush Fire” into the surrounding basis pontis. Extrapontine sites such as internal capsule, basal ganglia, cerebellum, and cerebrum can also be affected. We report a case of 60-year-old male with history of chronic alcoholism who presented to us with severe neurological deficits 10 days after his episode of severe hyponatremia.

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  1. Adams RD, Victor M, Mancall EL. Central pontine myelinolysis: A hitherto undescribed disease occurring in alcoholic and malnourished patients. AMA Arch Neurol Psychiatry 1959;81(2): 154–172. DOI: 10.1001/archneurpsyc.1959.02340140020004.
  2. Benders P, Heijckmann AC, van de Langerijt B, Polman LJ, Ramakers BP. Central pontine myelinolysis: Case report and short overview. Neth J Crit Care. 2017; 25(4):129–132.
  3. Martin RJ. Central pontine and extrapontine myelinolysis: The osmotic demyelination syndromes. J Neurol Neurosurg Psychiatry 2004;75 (Suppl. 3):iii22–iii28. DOI: 10.1136/jnnp.2004.045906.
  4. Rao PB, Azim A, Singh N, Baronia AK, Kumar A, Poddar B. Osmotic demyelination syndrome in intensive care unit. Indian J Crit Care Med 2015;19(3):166–169. DOI: 10.4103/0972-5229.152760.
  5. Koul PA, Khan UH, Jan RA, Shah S, Qadri AB, Wani B, et al. Osmotic demyelination syndrome following slow correction of hyponatremia: Possible role of hypokalemia. Indian J Crit Care Med 2013;17(4):231–233. DOI: 10.4103/0972-5229.118433.
  6. Brown WD. Osmotic demyelination disorders: Central pontine andextrapontine myelinolysis. Curr Opin Neurol 2000;13(6):691–697. DOI: 10.1097/00019052-200012000-00014.
  7. T Berl. Treating hyponatremia: Damned if we do and damned if we don't. Kidney Int 1990;37(3):1006–1018. DOI: 10.1038/ki.1990.78.
  8. Bakst R, Kasper M, Greene R. Central pontine myelinolysis in a patient admitted for alcohol withdrawal. Hosp Physician 2008;44:23–28.
  9. Chatterjee K, Fernandes AB, Goyal S, Shanker S. Central pontine myelinolysis in a case of alcohol dependence syndrome. Ind Psychiatry J 2015;24:198–201. DOI: 10.4103/0972-6748.181732.
  10. Oke IO, Mughees W, Patel H, Oladunjoye O, York E. A case of osmotic demyelination syndrome in a chronic alcoholic with moderate hyponatremia. Cureus 2012;13(5):e15129. DOI: 10.7759/cureus.15129.
  11. Sterns RH, Riggs JE, Schochet SS. Osmotic demyelination syndrome following correction of hyponatremia. N Engl J Med 1986;314(24):1535–1542. DOI: 10.1056/NEJM198606123142402.
  12. Sterns RH, Silver SM. Brain volume regulation in response to hypo–osmolality and its correction. Am J Med 2006;119(7):S12–S16. DOI: 10.1016/j.amjmed.2006.05.003.
  13. Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol 2014; 170(3):G1–47. DOI: 10.1530/EJE-13-1020.
  14. Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, et al. Diagnosis, evaluation, and treatment of hyponatremia: Expert panel recommendations. Am J Med 2013;126(10):S1–S42. DOI: 10.1016/j.amjmed.2013.07.006.
  15. Hoorn EJ, Zietse R. Diagnosis and treatment of hyponatremia: Compilation of the guidelines. J Am Soc Nephrol 2017;28(5): 1340–1349. DOI: 10.1681/ASN.2016101139.
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