Central Pontine Myelinolysis

The primary cause of this disorder does not appear to be specifically alcohol induced but caused by a secondary electrolyte disturbance (pp. 610 f) in the sense of hyponatremia (Endo et al. 1981), and especially the rapid clinical correction of an existing hyponatremia (Kleinschmidt-DeMasters and No-renberg 1981; Illowski and Laureno 1993). A combination with other factors has also been discussed (Bratzke and Neumann 1989; Mundle et al. 1999).

The main morphological feature of central pon-tine myelinosis is a glial-myelinolytic process, seen mainly in the rostral central cerebellar peduncle. Macroscopically it is characterized by clearly demarcated symmetrical demyelination of the central pontine segments, mainly in the raphe (Fig. 18.5). Microscopically there is a selective demyelination process involving neurons and axons with oligodendrocyte

Fig. 18.5. Central pontine myelinolysis. Demyelination in the center of the pons, characterized by a spongiform degeneration, axonal swelling, and increase of macrophages

loss. Macrophage proliferation is combined with the spongy disintegration.

The clinical picture is dominated by pseudobulbar paralytic symptoms such as dysphagia, dysarthria, and paralysis of deglutition. The picture can progress to decerebrate rigidity (Berlet et al. 1983). With increased awareness, the causal diagnosis is now made more often clinically, and with computed tomography and magnetic resonance imaging.

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