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DIAGNOSIS:Extrapontine Myelinolysis (EPM)
Osmotic myelinolysis (OM) is a toxic demyelinating disease that occasionally occurs in alcoholic, malnourished, or chronically debilitated adults. Over 75% of cases are associated with chronic alcoholism and rapid correction of hyponatremia.
Pathologically, OM is characterized by myelin loss with relative neuron sparing. The central pons is the most common site (central pontine myelinolysis or CPM), although OM occurs in other locations. So-called extrapontine myelinolysis (EPM) is identified pathologically in about half of all cases of demyelination. Reported extrapontine sites include the putamina, caudate nuclei, midbrain, thalami and the subcortical white matter.
Imaging manifestations of OM reflect increased water content in the affected areas. Plain CT scans are usually normal or show non-specific hypodense areas. OM lesions are hypointense on T1W and hyperintense on T2W MRI. Transverse pontine fibres are most commonly affected, whereas the descending corticospinal tracts are often spared. Enhancement following contrast administrating varies; some lesions enhance but most do not.
This particular patient had hyponatremia (serum sodium levels were 90 mmol/l), which was rapidly corrected, following which he developed the symptoms described above.
References:
1. Diagnostic Neuroradiology, Osborn Anne G : Diagnostic Neuroradiology; pp 763, Harcout Brace & company Asia PTE LTD, 1994
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2. Atlas S.W: Magnetic Resonance Imagine of Brain and Spine, ed 3, pp 502-505, Philadelphia; Lippincott William and Wilkins, 2002
3. Pubmed reference : http://www.ncbi.nlm.nih.gov/sites/entrezPubMed References for Extrapontine Myelinolysis (EPM)
At any given time this link will provide references from Pubmed, including the most recent updates. Retrievals are designed to include articles available free and also Indian studies. For Indian articles, in case there is no link to the full article,you could check out the archives from the journal's website, through this list.
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