MRI Brain in a Patient Recovering from Central Pontine Myelinolysis (CPM)

T1W MRI (Axial) showing hypointensity in pons
T2W Axial MRI showing hyperintensity in pons (red) and midbrain (yellow)
T2W Sagittal MRI brain showing hyperintensity in pons
FLAIR Axial MRI showing hyperintensity in pons

Central pontine myelinolysis (CPM) is a condition characterized by demyelinating lesions in pons, usually secondary to rapid correction of hyponatremia. In some cases, extrapontine areas such as basal ganglia, midbrain, thalamus and cerebellum may also be involved. Patients with CPM present with quadriplegia, encephalopathy, seizures, dysphagia, dysarthria, etc.

Our patient was a 30-year old lady who presented with severe hyponatremia (105 mmol/L). She was comatose at presentation. Hyponatremia was corrected, after which she clinically improved. However, 48 hours later, she worsened and developed quadriplegia, drowsiness, dysphagia and dysarthria. MRI brain showed features of central pontine myelinolysis. Supportive treatment was started. She remained in hospital for three weeks with minimal improvement. She was quadriplegic at discharge and was fed through Ryle’s tube. Physiotherapy was continued from home.

She returned for review 5 months later with remarkable improvement. She was conscious, alert and coherent. Speech and swallowing were normal. She had mild gait ataxia and mild confusion. MRI brain done at that stage showed features of past CPM with no edema.

In our patient, there was good clinical recovery. However, good recovery is not common in CPM. Death is common in patients with CPM. Survivors have severe disability including quadriparesis and pseudobulbar palsy.

Published by Dr Sudhir Kumar MD (Medicine) DM (Neurology)

I am a doctor with 25 years experience. I have worked as a neurologist for about 20 years. Educating public and healthcare professionals is very dear to me. This is possible due to my interactions with thousands of patients and their caregivers. I salute the patients who suffer and it is our duty to minimise suffering by preventing diseases and ensuring prompt diagnosis and treatment of those already affected.

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