Central pontine myelinolysis: a report of 5 cases with autopsy pathological analysis / 中华神经科杂志

ABSTRACT

Objective A series of 5 patients with central pontine myelinolysis (CPM) confirmed either by cranial MRI,CT image (4 cases) or by autopsy pathological analysis (1 case) was reported. The pathophysiological mechanism,the early diagnosis and the role in prevention were discussed. Methods The creteria obtained from clinical features, cranial MRI and CT imagine as well as autopsy pathological changes were thoroughly analyzed. Results ① All 5 case of CPM were occurring in patients who had already had somatic disease and serious systemic functional failure, especially in those who had had seriously water and ion disturbances, such as hyponatremia. ② In 4 of the 5 patients, psychiatric manifestation tended to show the earliest clinical features. ③ The pseudobulbaral paralysis appeared in 4 patients. ④ Cranial MRI and CT served as the most reliable techniques for diagnosing CPM cases when patients are still alive. ⑤ A variety of paralysis were found in all of the 5 CPM patients. ⑥Pathological analysis demonstrated that there is a symmetric unspecific myelinolysis in areas of basal pontine, caudal middle brain and the superior medulla (1 patient). Conclusion ① The occurrence of hyponatrimia and its too fast correction may be associated with the onset of CPM. ② CPM, a self-restrained disease can be cured from dangerous complications, such as pneumonia, respiratory failure and malnutrition when suitably treated.