If someone is sick and hospitalized with low body water and salt levels, doctors will give them saline to make up for the deficiency. That's normal. But did you know that sometimes, if the body's low sodium levels are suddenly and rapidly increased, it can damage the brain? That's what we call a rare but serious condition called Central Pontine Myelinolysis. Although the name is a bit complicated, let's talk about it simply.
Simply put, what kind of situation is this?
This is a disease related to the nervous system. The electrical signals that the body needs travel through the nerve cells (neurons) in our brain. There is a protective covering around these nerve cells. We call it the myelin sheath . It is like the plastic sheath around an electric wire. This myelin sheath is what allows the electrical signals to travel quickly and without any obstacles.
Central Pontine Myelinolysis (CPM) occurs when the myelin sheaths in a specific area of the brain, specifically the pons, become damaged. This damage can affect the function of various parts of the body.
Sometimes, in about 10% of cases, this damage can affect not only the pons, but also other parts of the brain. Therefore, this condition is known by another broader name. That is Osmotic Demyelination Syndrome (ODS) .
This condition is not common, but it has been found that about 2.5% of patients admitted to intensive care units (ICUs) are at risk of developing ODS.
What is the reason for this situation?
The main reason for this is that when the body's sodium level (which is what is in the salt we eat) is very low, it is suddenly and very quickly increased. This risk is especially increased when the body's sodium level has been low for more than two days and treatment is being given.
The important thing is, this is not something we eat or drink. This is something that can happen in a hospital, when sodium is given intravenously , that is, through saline, as a medical treatment.
Think about it this way. A person has been vomiting a lot for days, or has diarrhea. Then, not only water, but also salts like sodium are lost from their body. When they come to the hospital, their sodium levels are very low. Now the doctors are giving them saline to try to bring their sodium levels back to normal. However, if they are not aware of the other risk factors the patient has, they may be able to increase the sodium levels a little faster.
When that happens, the water inside the brain cells suddenly leaks out of the cells. The cells shrink like a dried grape. This sudden change is what damages the myelin sheaths we mentioned.
Who is at higher risk?
Not everyone develops this condition when their sodium levels are raised too quickly, but some people are at higher risk.
| Risk group | Description |
|---|---|
| Alcohol addicts | Nutritional deficiencies and salt imbalances are common in people who drink alcohol for a long time. |
| Liver transplant patients | This risk is especially high for those who have undergone liver transplant surgery. |
| Hyperemesis during pregnancy | Hyperemesis Gravidarum, a condition of incessant vomiting during pregnancy, can cause severe drops in the body's salt levels. |
| Long-term illnesses | Any other long-term medical condition that weakens the body or causes malnutrition increases the risk. |
What are the symptoms of this disease?
Symptoms usually begin to appear within two to three days of correcting the body's sodium levels. There are symptoms that appear early, as well as symptoms that appear weeks later.
| CPM symptoms | |
|---|---|
| Early symptoms (within 2-3 days) | |
| |
| Symptoms that may appear later (after a few weeks or months) | |
|
But don't be afraid. Although the mortality rate was initially thought to be high, that was determined by autopsy. According to new data, 94% of people who develop the condition survive . Also, between 25% and 40% of them recover completely . However, between 25% and 30% may be left with some permanent disability.
How do doctors find this?
The best way to diagnose this disease is with an MRI (Magnetic Resonance Imaging) scan . Your doctor will look at the MRI images of your brain and check for specific changes that indicate damage to the myelin sheaths.
Sometimes this damage doesn't show up on an MRI right away, so your doctor may ask you to have another MRI in a week or two.
CPM can look like several other conditions on MRI images. Therefore, doctors are very careful not to confuse this condition with the following diseases.
- Multiple Sclerosis
- Autoimmune or infectious encephalitis (inflammation of the brain)
- Central nervous system vasculitis
- Some types of cancer
If the MRI alone cannot clearly show the damage, the doctor will perform a more in-depth neurological exam. This may include tests that measure electrical signals in the brain, such as an EEG (electroencephalography).
How to treat? Prevention is the best!
In fact, the main treatment for Central Pontine Myelinolysis is to prevent the condition from occurring .
It's extremely important to let your medical team know about any risk factors you have (for example, if you drink alcohol, if you have other medical conditions) so they can safely and slowly increase your sodium levels.
If you develop this condition, treatment will depend on the symptoms you are experiencing. In many cases, months of physical therapy and other rehabilitation treatments will be required.
If you develop symptoms similar to Parkinson's disease, such as tremors, your doctor may prescribe dopaminergic medications .
During your stay in the hospital, preventing further secondary complications is also a key part of treatment. The medical team will be constantly monitoring things like:
- Dependence on a ventilator
- Urinary tract infections
- Pneumonia
- Blood clot in the vein (Deep vein thrombosis)
- Muscle atrophy
There are even clinical trials underway for this disease, and your doctor may recommend one.
Take-Home Message
- Central Pontine Myelinolysis (CPM) is a serious condition caused by damage to the myelin sheaths in the brain due to a sudden and rapid increase in low sodium (salt) levels in the body.
- The best treatment for this is prevention . Before you receive any treatment, tell your doctor your complete medical history, especially about alcohol use or other illnesses.
- If this condition occurs, the chances of survival are high, but full recovery can take a long time, including physical therapy.
- If you or someone you know experiences these symptoms, especially after undergoing sodium replacement therapy in a hospital, notify a doctor immediately.
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