Fact-sheet: Extrapontine myelinolysis
Updated on 03/31/2020 at 9:42 AM
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Definition
Demyelinating disorder of the central nervous system
Rare but well-known complication of hyponatremia and its overly rapid correction
Rarely occurs in the absence of central pontine myelinolysis.
Poor prognosis
Central pontine myelinolysis and extrapontine myelinolysis are now referred to as "osmotic demyelination syndrome"
Clinical features
Neuropsychiatric presentation:
- anxiety
- catatonia
- dysphagia
- extrapyramidal syndrome
Laboratory findings
Hyponatremia
CT
Hypodensities of the basal ganglia and brainstem may be found
MRI
Look for the following abnormalities, hyperintense on T2 and T2 FLAIR and hypointense on T1:
- thalami
- basal ganglia
- caudate nucleus
- internal, external, extreme capsule
- gray-white matter junction
- splenium of the corpus callosum
Management
Progressive correction of hyponatremia