Graff-Radford J, Fugate JE, Kaufmann TJ et al. Clinical and radiologic correlations of central pontine myelinolysis. Mayo Clin Proc 2011; 86: 1063-1067.
Authors did a chart review of patients with definite CPM seen at Mayo over 11 years and found 24 cases. Key points:
1. MRI T2 signal abnormality even if extensive does not predict clinical outcome as some patients with bad MRI recovered.
2, Half had CPM only, half also had extrapontine myelinolysis especially thalamic
3. Causes were rapid correction of Na (67%), hyperosmolar hyperglycemia (4 %), hyperammonemia (n=1) and unknown (n=6). 75 % were alcoholics and 50 % were malnourished with albumen mean 2.6. Half were chronically hypertensive, one third were taking diuretics, 17 % had DM and 1 had ahad liver-kidney transplant. Forty percent of hyponatremic patients also were hypokalemic, and mean nadir of Na was 114.
4. Presentations included encephalopathy (75 %), ataxia (46 %), dysarthria (29 %), eom abnormalities (25 %), seizures (21 %), eps including chorea.
5. Initial MRI was negative in 5 patients and became positive later.
6. Four of 14 patients so tested had Gd+ lesion on MRI
7. Ten of 24 patients achieved favorable outcome (mRS<2) at discharge, 15/24 were favorable at 22 months.
8. Many patients did not have prior IWMD
Authors did a chart review of patients with definite CPM seen at Mayo over 11 years and found 24 cases. Key points:
1. MRI T2 signal abnormality even if extensive does not predict clinical outcome as some patients with bad MRI recovered.
2, Half had CPM only, half also had extrapontine myelinolysis especially thalamic
3. Causes were rapid correction of Na (67%), hyperosmolar hyperglycemia (4 %), hyperammonemia (n=1) and unknown (n=6). 75 % were alcoholics and 50 % were malnourished with albumen mean 2.6. Half were chronically hypertensive, one third were taking diuretics, 17 % had DM and 1 had ahad liver-kidney transplant. Forty percent of hyponatremic patients also were hypokalemic, and mean nadir of Na was 114.
4. Presentations included encephalopathy (75 %), ataxia (46 %), dysarthria (29 %), eom abnormalities (25 %), seizures (21 %), eps including chorea.
5. Initial MRI was negative in 5 patients and became positive later.
6. Four of 14 patients so tested had Gd+ lesion on MRI
7. Ten of 24 patients achieved favorable outcome (mRS<2) at discharge, 15/24 were favorable at 22 months.
8. Many patients did not have prior IWMD
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