Surgical repair of humerus fracture in a patient with central pontine myelinolysis

Introduction Central pontine myelinolysis (CPM) is a rare neurologic disorder involving severe damage to the myelin sheath of nerve cells in the pons. Clinical features usually include tetraparesis, pseudobulbar palsy and altered mental status. Objective To review a case of humerus fracture in a female with CPM. Material and methods A 65-year-old patient with CPM sustained humerus fracture that was first treated conservatively. With two neurological examinations and a clinical case conference the humerus fracture of the high-risk patient was nailed. Results No neurological deterioration was observed postoperatively. A satisfactory bone alignment was noted radiologically. The patient was discharged from the hospital with a satisfactory outcome. Discussion The favorable outcome suggests that patients with CPM can benefit from surgical treatment. Conclusion CPM cannot be considered an absolute contraindication for surgical treatment, however, further study is required.

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Central Pontine Myelinolysis in Pediatric Diabetic Ketoacidosis

Case Reports in Critical Care ◽

10.1155/2018/4273971 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Hannah Kinoshita ◽

Leon Grant ◽

Konstantine Xoinis ◽

Prashant J. Purohit

Keyword(s):

Diabetic Ketoacidosis ◽

Cerebral Edema ◽

Central Pontine Myelinolysis ◽

Altered Mental Status ◽

Subdural Hemorrhage ◽

Transient Improvement ◽

Bicarbonate Therapy ◽

Pontine Myelinolysis ◽

Poor Outcomes ◽

Central Pontine

Central pontine myelinolysis (CPM) is rarely reported in pediatric patients with diabetic ketoacidosis (DKA). We report this case of a 16-year-old female with new onset diabetes presenting with DKA, who received aggressive fluid resuscitation and sodium bicarbonate in the emergency department. Later she developed altered mental status concerning for cerebral edema and received hyperosmolar therapy with only transient improvement. Soon she became apneic requiring emergent endotracheal intubation. MRI brain showed cerebral edema, CPM, and subdural hemorrhage. She was extubated on day seven and exhibited mild dysmetria, ataxia, unilateral weakness, and neglect. Upon discharge she was able to ambulate with a walker and speak and eat without difficulty. Although less common than cerebral edema, CPM should be considered in DKA patients with acute neurologic deterioration. Fluid and bicarbonate therapy should be individualized, but larger studies would help guide the management. Although poor outcomes are reported in CPM, favorable outcomes are possible.

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Acute Psychosis as Main Manifestation of Central Pontine Myelinolysis

Case Reports in Neurological Medicine ◽

10.1155/2017/1471096 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Mangala Gopal ◽

Melvin Parasram ◽

Harsh Patel ◽

Chike Ilorah ◽

Hrachya Nersesyan

Keyword(s):

Central Pontine Myelinolysis ◽

Laboratory Data ◽

Clinical Manifestations ◽

Brain Magnetic Resonance Imaging ◽

Neurological Deficits ◽

Pseudobulbar Palsy ◽

Acute Psychosis ◽

Pontine Myelinolysis ◽

Neuropsychiatric Manifestations ◽

Central Pontine

Central pontine myelinolysis (CPM) is an acute demyelinating neurological disorder affecting primarily the central pons and is frequently associated with rapid correction of hyponatremia. Common clinical manifestations of CPM include spastic quadriparesis, dysarthria, pseudobulbar palsy, and encephalopathy of various degrees; however, coma, “locked-in” syndrome, or death can occur in most severe cases. Rarely, CPM presents with neuropsychiatric manifestations, such as personality changes, acute psychosis, paranoia, hallucinations, or catatonia, typically associated with additional injury to the brain, described as extrapontine myelinolysis (EPM). We present a patient with primarily neuropsychiatric manifestations of CPM, in the absence of focal neurologic deficits or radiographic extrapontine involvement. A 51-year-old female without significant medical history presented with dizziness, frequent falls, diarrhea, generalized weakness, and weight loss. Physical examination showed no focal neurological deficits. Laboratory data showed severe hyponatremia, which was corrected rather rapidly. Subsequently, the patient developed symptoms of an acute psychotic illness. Initial brain magnetic resonance imaging (MRI) was unremarkable, although a repeat MRI two weeks later revealed changes compatible with CPM. This case demonstrates that acute psychosis might represent the main manifestation of CPM, especially in early stages of the disease, which should be taken into consideration when assessing patients with acute abnormalities of sodium metabolism.

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Central pontine myelinolysis

Archives of Internal Medicine ◽

10.1001/archinte.119.5.444 ◽

1967 ◽

Vol 119 (5) ◽

pp. 444-478 ◽

Cited By ~ 6

Author(s):

W. F. McCormick

Keyword(s):

Central Pontine Myelinolysis ◽

Pontine Myelinolysis ◽

Central Pontine

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Ayurvedic understanding of Central Pontine Myelinolysis - A Case Report

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.v3i3.12900 ◽

2018 ◽

Vol 3 (3) ◽

Author(s):

Anoop AS ◽

Lakshmiprasad L. Jadhav ◽

Sruthy Nair ◽

Rohan Mohandas

Keyword(s):

Serum Sodium Level ◽

Central Pontine Myelinolysis ◽

Chronic Alcoholism ◽

Serum Electrolyte ◽

Oral Medications ◽

Shoulder Joints ◽

Pontine Myelinolysis ◽

Chief Complaints ◽

Hyponatremic Encephalopathy ◽

Central Pontine

A 56 year old male patient was admitted to S.D.M Ayurveda Hospital, Hassan, Karnataka with the confirmed diagnosis of Central Pontine Myelinolysis (CPM) on 11/12/17. The chief complaints were weakness of both hands and legs, stiffness in both hands and legs, pain in both shoulder joints, slurred speech, difficulty in walking with gait changes. H/O chronic alcoholism. MRI brain showed pontine and basal ganglia diffusion restriction - Acute Pontine Myelinolysis. The serum electrolyte showed serum sodium level as 128 mmol/litre. This disease can be understood as Samana Avruta Vyana in hyponatremic encephalopathy stage and the stage of myelinolysis can be understood as Sarvanga Vata with Kapha Avruta Udana and Vyana. After clinical evaluation, Avarana Chikitsa was started followed by Kevala Vatika Chikitsa and significant improvement was seen. Significant result was observed in subjective and objective parameters after the treatment. The patient was discharged with oral medications for 1 month.

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