entral pontine and extrapontine myelinolysis (CPM) is clinically charaterized by
quadriplegia, pseudobulbar palsy, and consciousness change, usually following rapid correction
of hyponatremia, but the exact mechanism of the pathophysiology remains obscure.
Pathologic study reveals well-circumscribed areas of myelin loss sparing neurons and axons
in pons and extrapontine region. Vascular changes and inflammation are absent. In the past,
the diagnosis of CPM has generally been made on the basis of autopsy findings, but at the
present, magnetic resonance imaging has made it possible to make the diagnosis before
autopsy for the detection of pontine and extrapontine lesions.
We report three cases of central pontine and extrapontine myelinolysis associated with
typical clinical symptoms following rapid correction of hyponatremia. MRI showed
high-signal areas in basis pontis, bilateral thalamus, caudate nucleus, and putamen.
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