Central pontine and extrapontine myelinolysis

Central pontine myelinolysis (CPM) was described by Adams and colleagues in 1959 as a disease affecting alcoholics and the malnourished. Also known as osmotic demyelination syndrome (ODS), PM (Pontine Myelinosis) is subdivided into central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM). Each is identified at the level of demyelination, either centered within the pons or outside the pons, respectively. Despite its relatively ambiguous pathogenesis, it is believed that rapid correction of hyponatremia plays a pivotal role in pathogenesis of ODS. Whenever a patient who is gravely ill with alcoholism and malnutrition or a systemic medical disease develops confusion, quadriplegia, pseudobulbar palsy, and pseudocoma (locked-in syndrome) over a period of several days, one is supposed to have a high index of suspicion for central pontine myelinolysis.