Central pontine myelinolysis with meticulous correction of hyponatraemia in chronic alcoholics

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Central pontine myelinolysis is a demyelinating disorder that arises due to osmolar disturbances in the cerebral microenvironment characterised by loss of the myelin sheath of neurons. The diffusion-weighting imaging sequence of MRI is the most sensitive diagnostic imaging modality for myelinolysis. The rapid correction of hyponatraemia by >20–25 mmol/L/48 h has been known for a long time as a prime cause of osmotic demyelination. Various other comorbidities in hyponatraemic patients are well known that can lead to osmotic demyelination such as alcoholism, hypoxaemia, severe liver disease, malignancy, burns, liver transplantation and malnutrition. Chronic alcohol abusers with additional liver disease and malnutrition have altered osmotic equilibrium at baseline that predisposes them to osmotic demyelination. We suggest a more cautious and meticulous approach should be followed in these patients to avoid the dreaded complication.

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