What causes central pontine myelinolysis (CPM)?

Updated: Oct 09, 2017
  • Author: Christopher Luzzio, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Conditions predisposing patients to central pontine myelinolysis include alcoholism, liver disease, malnutrition, and hyponatremia.

Risk factors for central pontine myelinolysis in the hyponatremic patient include the following:

  • Serum sodium of less than 120 mEq/L for more than 48 hours

  • Aggressive IV fluid therapy with hypertonic saline solutions

  • Development of hypernatremia during treatment

Many patients who have hyponatremia that is corrected rapidly do not develop central pontine myelinolysis. Thus, other less obvious risk factors probably exist. Central pontine myelinolysis reportedly occurs occasionally in patients who are treated for hypernatremia.

Central pontine myelinolysis may complicate liver transplantation surgery. [8] Consider central pontine myelinolysis when confusion and/or weakness complicate the liver transplant patient's postoperative recovery. The author provided consultation for a liver transplant patient who developed central pontine myelinolysis and critical illness neuromyopathy. The typical exam findings for central pontine myelinolysis were masked by peripheral nerve and muscle disease. MRI studies provided conclusive evidence for brain stem demyelination.

Burn patients with a prolonged period of serum hyperosmolality are prone to developing central pontine myelinolysis. Central pontine myelinolysis also has occurred concurrently with Wilson disease and neoplasia.

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