Pontine central myelinolysis: symptoms, causes and prospects



What is Pontine's central myelinolysis?


Central pontine myelinolysis (CPM) is a neurological disorder that affects the brain. "Pontine" refers to the brain stem, called pons. "Myelinolysis" means that myelin, a covering that protects pontine nerve cells, is being destroyed.


CPM usually occurs as a result of another disease or medical condition. The destruction of myelin in general is not spontaneous.


People who have CPM can not be cured, but their symptoms can be treated. Damage to the nerves can become chronic and can lead to permanent disabilities. Some people will need help with dressing, feeding, and other routine tasks.


In rare cases, CPM can lead to confined syndrome, coma or even death. Blocking syndrome is a condition in which all mobility and muscle control is lost. People with locked-in syndrome can only move their eyes.


Symptoms of Pontine's central myelinolysis


The symptoms of CPM involve both movement and cognitive function. Damage to your myelin sheaths can cause nerve damage to the brainstem.


Damage to nerves interferes with communication between the nervous system and muscles. As a result, you may suffer from:



  • Muscular weakness in the face, arms and legs.

  • Reflections and delayed or poor responses.

  • slow speech and poor enunciation

  • tremors

  • difficulties swallowing

  • poor balance


CPM can also damage your brain cells. The damage can affect your mental health as well as your physical health. You may experience mental confusion or hallucinations, or you may appear to be in a delirious state. Some people suffer from intellectual deterioration as a result of central pontine myelinolysis.


Causes of Pontine's central myelinolysis


The most common cause of CPM is a rapid increase in sodium levels in the blood. Sodium is a mineral electrolyte that carries an electrical charge in your body. Sodium helps regulate your fluid levels, making sure your cells are well hydrated. Central pontine myelinolysis can occur when levels of sodium in the blood rise sharply and rapidly. The reason for this damage is not yet clear, but it involves the rapid change of water in brain cells.


People who are treated for hyponatremia have a higher risk of developing CPM. Hyponatremia is the state of low levels of sodium in the blood. Hyponatremia can cause a variety of health conditions. These may include:



  • nausea

  • barf

  • muscle cramps

  • seizures

  • coma


Treatment for low sodium levels includes the intravenous infusion of a sodium solution and can cause the sodium level to rise too quickly. It is more likely to develop central pontine myelinolysis if it delays the treatment of hyponatremia for two days or longer.


Chronic alcoholism, liver disease and malnutrition increase your risk of developing CPM. These conditions can cause changes in your sodium levels.


Diagnosis of Pontine's central myelinolysis


Your doctor will perform blood tests to measure your sodium levels and help diagnose CPM. MRI is a test that uses radio waves to create images of your internal organs. An MRI of your head can show any damage to your brain stem.


You can also take a brainstem auditory evoked response (BAER) test. Your doctor will place electrodes on your head and ears, and then play a series of clicks and other sounds through the headphones. BAER measures the response time and brain activity when listening to each sound.


Treatment for pontine central myelinolysis


CPM is a serious medical condition and should be treated in case of emergency. Get medical attention as soon as possible if you experience symptoms compatible with the condition. The treatment is aimed at controlling your symptoms and may include:



  • Fluids and medications to safely regulate your sodium levels.

  • Dopaminergic medications (such as levodopa) to increase dopamine and control tremors and speech and swallowing difficulties in people who develop Parkinson's symptoms

  • Physiotherapy to improve balance and maintain range of motion.


Perspectives for Pontine's central myelinolysis


People with CPM can get better with the right treatment, but they can still have chronic problems with balance, mobility and response time. Originally it was believed that the CPM had a mortality rate of 50 percent, but early diagnosis has improved the outlook. Although some people still die as a result of the damage suffered, many people with CPM can recover. Most people who have recovered from CPM will still need some ongoing therapy and supportive care to manage the long-term effects.


Prevention of Pontine's central myelinolysis


It is important to monitor your blood sodium levels to help prevent CPM. If you have a condition that puts you at risk for hyponatremia, make sure you are aware of the symptoms of low blood sodium and stay on top of your treatment.
It is important to stay adequately hydrated to maintain fluid balance and sodium levels in your body. Staying hydrated daily is always recommended.



Reference: https: //www.healthline.com/health/central-pontine-myelinolysis






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