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Korean J Neurotrauma 2022 Apr 14;18(1):89-94. Epub 2021 Dec 14.

Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea.

Central pontine myelinolysis (CPM) is a disorder wherein variable symptoms are associated with pontine dysfunction. It has been known to occur inconstantly, particularly when serum sodium in patients with prolonged hyponatremia is rapidly corrected. Further, it is known that patients with liver diseases, malnutrition, malignancy, adrenal insufficiency, and metabolic derangements are more vulnerable to this disorder. Read More

J Clin Exp Hepatol 2022 Mar-Apr;12(2):714-715. Epub 2021 Jul 28.

Department of Hepatobiliary Surgery and Liver Transplantation, Dr. Rela Institute & Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India.

Central pontine myelinolysis (CPM) is a rare neurological complication reported in liver transplant recipients. A 16-year-old boy with Wilson disease underwent a living donor liver transplant for acute-on-chronic liver failure. On postoperative day 7, he was noted to have diplopia, dysphagia, and bilateral lower limb weakness with wide base gait with gradual progression to akinetic mutism. Read More

Clin Liver Dis 2022 05 1;26(2):149-164. Epub 2022 Apr 1.

Department of Nephrology, Ochsner Health, 1514 Jefferson Highway, Clinic Tower 5th, Floor, Room 5E328, New Orleans, LA 70121, USA; Ochsner Clinical School/The University of Queensland, Brisbane, Queensland, Australia. Electronic address: https://twitter.com/VelezNephHepato.

Hyponatremia is the most common electrolyte disorder encountered in clinical practice, and it is a common complication of cirrhosis reflecting an increase in nonosmotic secretion of arginine vasopressin as a result of of the circulatory dysfunction that is characteristic of advanced liver disease. Hyponatremia in cirrhosis has been associated with poor clinical outcomes including increased risk of morbidity and mortality, poor quality of life, and heightened health care utilization. Despite this, the treatment of hyponatremia in cirrhosis remains challenging as conventional therapies such as fluid restriction are frequently ineffective. Read More

Fortschr Neurol Psychiatr 2022 Apr 28. Epub 2022 Apr 28.

Department of Psychiatry, University of Health Science-Gulhane Teaching and Research Hospital, Ankara, Turkey.

Introduction: Delirium tremens (DT) is a serious condition occurring in alcohol withdrawal syndrome. Alcohol consumption may also cause additional health problems, such as respiratory infections or neuropsychiatric conditions such as central pontine myelinolysis. In this clinical scenario, managing DT can be expected to be more compelling and complex. Read More

Kidney360 2021 Sep 8;2(9):1415-1423. Epub 2021 Jul 8.

Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Background: Overly rapid correction of chronic hyponatremia may lead to osmotic demyelination syndrome. European guidelines recommend a correction to ≤10 mEq/L in 24 hours to prevent this complication. However, osmotic demyelination syndrome may occur despite adherence to these guidelines. Read More

Case Rep Neurol 2022 Jan-Apr;14(1):72-81. Epub 2022 Feb 15.

Institute of Neurology, National Hospital of Sri Lanka, Colombo, Sri Lanka.

Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are syndromes of osmotic demyelination attributed to the rapid correction of hyponatraemia. Isolated EPM is a rare clinical entity which poses a significant diagnostic challenge especially in the absence of a rapid rise in sodium. Typical MRI findings aid in the diagnosis. Read More

Clin Case Rep 2022 Mar 19;10(3):e05584. Epub 2022 Mar 19.

Nepal Medical College and Teaching Hospital Kathmandu Nepal.

Cautious treatment of hyponatremia in diabetic ketoacidosis is necessary in order to avoid the development of osmotic demyelination syndrome which is a demyelinating disorder. Individualized supportive therapy would be fruitful for the management of such cases but there is a need for larger studies to guide the management. Read More

PLoS One 2022 1;17(3):e0264641. Epub 2022 Mar 1.

Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.

Intracranial germinoma (IG) rarely occurs in adults. Its optimal treatment strategy is unclear. We evaluated the outcomes of radiotherapy in adults with intracranial germinoma. Read More

J Clin Med 2022 Feb 13;11(4). Epub 2022 Feb 13.

Department of Emergency Medicine, Anesthesiology and Intensive Care, Policlinico Umberto I, "Sapienza" University of Rome, 00161 Rome, Italy.

This systematic review presents clinical evidence on early and long-term cerebral diseases in liver transplant recipients. The literature search led to the retrieval of 12 relevant studies. Early postoperative cerebral complications include intracranial hemorrhage associated with a coexisting coagulopathy, perioperative hypertension, and higher MELD scores and is more frequent in critically ill recipients; central pontine and extrapontine myelinolysis are associated with notable perioperative changes in the plasma Na+ concentration and massive transfusion. Read More

BJR Case Rep 2021 Jul 23;7(4):20210005. Epub 2021 Mar 23.

Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia.

Central pontine myelinolysis (CPM), often referred to as osmotic demyelination syndrome, is most commonly seen in the setting of rapid correction of hyponatraemia. Although imaging is the key to diagnosis, conventional CT and MRI findings often lag the clinical manifestations and characteristic MRI changes may be delayed by up to 14 days. We present a case of a 45-year-old female with an extensive history of alcohol misuse and malnutrition who presented with left hemiparesis, initially suspected to be a stroke. Read More

Cureus 2021 Dec 8;13(12):e20281. Epub 2021 Dec 8.

Department of Internal Medicine, Medical Teaching Institution, Ayub Teaching Hospital, Abbottabad, PAK.

Central pontine myelinolysis is a non-inflammatory neurologic deficit and can have a wide array of clinical features, predisposing risk factors as well as different patterns of onset along with a big difference in prognosis ranging from asymptomatic cases to encephalopathy and also mortality. Apart from the common risk factors like hyponatremia and sudden correction of electrolyte imbalances, sometimes, the least prevalent risk factors such as pregnancy seem to link with the central pontine myelinolysis. Mostly its onset is sudden after the inciting factors. Read More

Radiol Case Rep 2022 Mar 20;17(3):604-609. Epub 2021 Dec 20.

University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44120, USA.

Osmotic demyelination syndrome, comprised of central pontine and extrapontine myelinolysis, is an important and potentially fatal complication primarily related to rapid overcorrection of serum sodium leading to devastating neurological symptoms. While traditionally presenting in the pons, we report the case of a 43-year-old female patient who recently underwent a liver transplant and developed extrapontine myelinolysis and subsequently central pontine myelinolysis resulting in irreversible spastic quadriparesis. This rare case highlights the variability of presentation of osmotic demyelination syndrome on imaging. Read More

Clin Toxicol (Phila) 2022 May 4;60(5):647-650. Epub 2022 Jan 4.

Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China.

Introduction: Diquat-related acute kidney injury is well-known. However, neurological disorders caused by diquat are often underestimated, and changes in the imaging findings are rarely reported. We present three cases of acute diquat poisoning resulting in toxic encephalopathy. Read More

Cureus 2021 Nov 16;13(11):e19644. Epub 2021 Nov 16.

Interventional Neuroradiology, Medicover Hospitals, Visakhapatnam, IND.

Central nervous system (CNS) involvement in Sjogren's syndrome (SS) has a broad spectrum of presentations. We present a 33-year-old with sudden onset, rapidly progressive quadriplegia, severe dysarthria, bilateral facial palsy, bulbar palsy, and hypernatremia. The MRI of the brain revealed hyperintensity in the central pons diffusion-weighted imaging, T2-weighted imaging, and fluid-attenuated inversion recovery (FLAIR) without abnormal contrast enhancement, consistent with central pontine myelinolysis. Read More

Cureus 2021 Nov 6;13(11):e19318. Epub 2021 Nov 6.

Medical Imaging, Chi Mei Medical Center, Tainan City, TWN.

We present a case that was initially misdiagnosed as drug-related extrapyramidal side effect. However, after the suspected causative drugs were withdrawn, the patient's condition did not improve. Neuroimaging revealed osmotic demyelination syndrome with a temporal pattern of change from extrapontine myelinolysis to central pontine myelinolysis. Read More

Am J Forensic Med Pathol 2022 Jun 14;43(2):195-198. Epub 2021 Dec 14.

Department of Pathology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI.

Abstract: Central pontine myelinolysis is most commonly associated with rapid correction of hyponatremia and has historically been associated with alcoholism. In this case report, 2 deaths with gross findings of central pontine lesions led to the possibility that CPM may have been a potential mechanism of death. Subsequent analysis revealed that these lesions were incidental findings. Read More

Aust N Z J Psychiatry 2021 Dec 9:48674211063141. Epub 2021 Dec 9.

Neuropsychiatry Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia.

BMJ Case Rep 2021 Nov 30;14(11). Epub 2021 Nov 30.

Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA

Central pontine myelinolysis (CPM) develops due to acute hypernatremia from a normal baseline serum sodium in the setting of electrolyte abnormalities induced by topiramate use. Topiramate is a commonly used medication with several indications including migraines, myoclonic jerks and seizures. It has been reported to cause renal tubular acidosis and severe electrolyte abnormalities, which in turn predispose patients to neuropathology via renal concentration defects and osmotic shifts. Read More

Cureus 2021 Oct 5;13(10):e18495. Epub 2021 Oct 5.

Department of Neurology, Advocate Christ Hospital, Oak Lawn, USA.

Central pontine myelinolysis (CPM) is a neurological disorder typically caused by rapid correction of severe chronic hyponatremia. Conditions causing a hyperosmolar state can also cause CPM, but it is rarely seen in diabetes. Here we describe a case of a 34-year-old female with longstanding uncontrolled diabetes mellitus who presented with bilateral upper and lower limb weakness and dysphagia. Read More

Brain Behav Immun Health 2021 Jan 23;10:100166. Epub 2020 Oct 23.

Department of Neurology, Adventist Health White Memorial, Los Angeles, United States.

We present a 48-year-old female patient with history of methamphetamine use who developed ataxia, gait difficulty, slurred speech, left Cranial Nerve 7 palsy and mild alteration in mental status. MRI findings suggest that the cause of her newly developed neurological problems is central pontine myelinolysis (CPM). Read More

J Family Med Prim Care 2021 Jul 30;10(7):2477-2481. Epub 2021 Jul 30.

Internal Medicine Department, Creighton University Hospital Program, Omaha, Nebraska, USA.

It is common upon admission or during stay at a hospital or intensive care unit (ICU) for patients to present with or acquire a serum sodium abnormality. Hyponatremia, serum sodium level less than 135 mmol/L, frequently associated with critical illnesses such as heart failure and liver cirrhosis, is an indicator of disease severity as well as a risk factor for poor prognosis. Hypernatremia, serum sodium level greater than 145 mmol/L, results due to any ailment disabling a patient's modality of thirst or the ability to relieve it once sensed. Read More

Intern Med J 2021 Sep;51(9):1545-1546

Department of Medicine, All India Institute of Medical Sciences, Delhi, India.

Bone Marrow Transplant 2021 12 16;56(12):3081-3083. Epub 2021 Sep 16.

Haematology and Transplant Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.

J Emerg Med 2021 11 12;61(5):e108-e112. Epub 2021 Sep 12.

Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India. Electronic address:

Background: Osmotic demyelination syndrome commonly occurs after rapid correction of hyponatremia. But it has also been reported after graded correction of hyponatremia in the presence of other risk factors like chronic alcoholism, malnutrition, liver disease, and hypokalemia.

Case Report: We report a case of a 67-year-old man who presented with dysphagia and nasal regurgitation and had features suggestive of bulbar palsy on neurological examination. Read More

BMJ Case Rep 2021 Sep 13;14(9). Epub 2021 Sep 13.

Monash Haematology, Monash Medical Centre Clayton, Melbourne, Victoria, Australia

Central pontine myelinolysis (CPM) is commonly associated with osmotic stress and rapid correction of hyponatraemia. It has rarely been reported in conjunction with malignancies. We report a case where CPM was not only associated with a new diagnosis of diffuse large B-cell lymphoma but was also a key presenting feature. Read More

Neurol Clin Pract 2021 Aug;11(4):304-310

Children's Hospital of Philadelphia (WF), PA; Department of Neurology (WF, ACV, FJM), Massachusetts General Hospital, Boston; Harvard Medical School (WF, FJM), Boston, MA.

Objective: To describe the long-term outcomes of osmotic demyelination syndrome (ODS) in an updated cohort.

Methods: We performed a retrospective medical records review of cases of ODS at the Massachusetts General and Brigham and Women's Hospitals using International Classification of Diseases-9th edition codes and a text-based search for , , and (1999-2018). Cases were individually selected based on patients having neuroimaging and symptoms consistent with ODS and no other potentially explanatory etiology. Read More

Front Med (Lausanne) 2021 3;8:693738. Epub 2021 Aug 3.

Department of Internal Medicine, The Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States.

Hyponatremia is the most common electrolyte disorder in clinical practice. Catastrophic complications can occur from severe acute hyponatremia and from inappropriate management of acute and chronic hyponatremia. It is essential to define the hypotonic state associated with hyponatremia in order to plan therapy. Read More

Mov Disord Clin Pract 2021 Aug 4;8(6):875-884. Epub 2021 Jun 4.

Department of Neurology National Institute of Mental health and Neurosciences Bengaluru India.

Background: Osmotic demyelination syndrome (ODS) can be a central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) based on the regions involved even though they share the same disease process, aetiopathogenesis and time course.

Objectives: Present study aims to characterize the clinical, radiological features and the outcome of patients with ODS with movement disorders as the forthcoming manifestation.

Methods: Chart review of patients with ODS with movement disorders. Read More

Cureus 2021 Jul 4;13(7):e16180. Epub 2021 Jul 4.

Hematology/Oncology, Mercy Catholic Medical Center, Darby, USA.

A 73-year-old African American male presented with altered mental status, severe hyperglycemia, and acute kidney injury. His metabolic derangements including hyperglycemia and hyponatremia were initially thought to be the cause of his encephalopathy. While managing his hyperglycemic hyperosmolar non-ketotic state, he received intravenous rehydration with almost three times his physiologic requirement for normalization of his electrolyte abnormalities. Read More

Clin Neurol Neurosurg 2021 Sep 24;208:106811. Epub 2021 Jul 24.

Medical School, University of Cyprus, Nicosia, Cyprus; Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus.

Background: Osmotic demyelination syndrome (ODS), which embraces central pontine and extrapontine myelinolysis, is an uncommon neurological disorder that occurs due to plasma osmotic changes.

Case Presentation: We present the case of a 55-year-old man, who presented with severe hyponatremia due to repeated vomiting, antidepressant treatment and consumption of large amounts of water. Fifteen days after sodium correction, the patient showed fluctuation of vigilance, dysarthria and dysphagia, tremor, cogwheel rigidity, bilateral facial palsy, ophthalmoplegia and tetraparesis. Read More