Quiz Form

Question Date: 31/01/2024

Question: All of the following factors are commonly associated with central pontine /extrapontine myelinosis except:

Options:

• Alcoholism
• Malnutrition
• Hemodialysis
• Post liver transplant

Correct Answer: Hemodialysis

Explaination: Disease states associated with CPM/EPM, often more than one association presentAlcoholism (common)Malnutrition (common)After prolonged diuretic use (frequent)Psychogenic polydipsia (rare if acute) Burns (infrequent, and often in context of hypernatraemia)Post-liver transplant (well recognised)Post-pituitary surgery (rare)Post-urological surgery/gynaecological surgery, especially if involving glycine infusions (rare)<br>The association with alcoholism was the first to be noted and continues to be particularly frequent (in up to 40% of cases)<br>Alcohol itself interferes with sodium/water regulation by suppression of antidiuretic hormone (ADH), and inadequate nutrition of alcoholics is an obvious accompaniment<br>Osmotic demyelination, however, does not seem to occur with the frequency one would expect in renal dialysis<br>It is thought that urea is acting in the renal failure patients as an ineffective solutethat is, it contributes to measured osmolality but as it easily crosses cell membranes does not contribute to tonicity, thus protecting from the rapid shifts in sodium which can occur in hemodialysis

Reference: Martin R J, CENTRAL PONTINE AND EXTRAPONTINE MYELINOLYSIS: THE OSMOTIC DEMYELINATION SYNDROMES; Neurol Neurosurg Psychiatry 2004;75(Suppl III):iii22iii28.