Editing Central pontine myelinolysis (section)

==Causes==
[[File:Pontine myelinolysis.jpg|thumb|right|Loss of myelinated fibers at the [[basilar part of the pons]] in the brainstem (Luxol-Fast blue stain)]]
The most common cause is overly-rapid correction of low blood sodium levels ([[hyponatremia]]).<ref name="pmid10544728">{{cite journal | vauthors = Bernsen HJ, Prick MJ | title = Improvement of central pontine myelinolysis as demonstrated by repeated magnetic resonance imaging in a patient without evidence of hyponatremia | journal = Acta Neurologica Belgica | volume = 99 | issue = 3 | pages = 189–193 | date = September 1999 | pmid = 10544728 }}</ref> Apart from rapid correction of hyponatraemia, there are case reports of central pontine myelinolysis in association with hypokalaemia, anorexia nervosa when feeding is started, patients undergoing dialysis and burn victims. There is a case report of central pontine myelinolysis occurring in the context of [[refeeding syndrome]], in the absence of hyponatremia.<ref name="pmid21949915"/>

It has also been known to occur in patients suffering withdrawal symptoms of chronic [[alcoholism]].<ref name="Yoon">{{cite journal | vauthors = Yoon B, Shim YS, Chung SW | title = Central pontine and extrapontine myelinolysis after alcohol withdrawal | journal = Alcohol and Alcoholism | volume = 43 | issue = 6 | pages = 647–649 | year = 2008 | pmid = 18678596 | doi = 10.1093/alcalc/agn050 | doi-access = free }}</ref>  In these instances, occurrence may be entirely unrelated to hyponatremia or rapid correction of hyponatremia. It could affect patients who take some prescription medicines that are able to cross the [[Blood–brain barrier|blood-brain barrier]] and cause abnormal thirst reception - in this scenario the central pontine myelinolysis is caused by [[polydipsia]] leading to low blood sodium levels (hyponatremia).{{cn|date=December 2020}}

In [[Schizophrenia|schizophrenic]] patients with [[Primary polydipsia|psychogenic polydipsia]], inadequate thirst reception leads to excessive water intake, severely diluting serum sodium.<ref>{{Cite web|url=http://www.apadivisions.org/division-31/publications/articles/british-columbia/psychogenic-polydipsia.pdf |archive-url=https://web.archive.org/web/20150407070947/http://apadivisions.org/division-31/publications/articles/british-columbia/psychogenic-polydipsia.pdf |archive-date=2015-04-07 |url-status=live|title=Psychogenic Polydipsia (Excessive Fluid seeking Behaviour)| vauthors = Donald H |publisher=American Psychological Society Divisions}}</ref> With this excessive thirst combined with psychotic symptoms, brain damage such as central pontine myelinolysis<ref>{{cite journal | vauthors = Lim L, Krystal A | title = Psychotic disorder in a patient with central and extrapontine myelinolysis | journal = Psychiatry and Clinical Neurosciences | volume = 61 | issue = 3 | pages = 320–322 | date = June 2007 | pmid = 17472602 | doi = 10.1111/j.1440-1819.2007.01648.x | doi-access = free }}</ref> may result from [[Osmotic concentration|hyperosmolarity]] caused by excess intake of fluids, ([[primary polydipsia]]) although this is difficult to determine because such patients are often [[institutionalised]] and have a long history of mental health conditions.<ref>{{cite journal | vauthors = Gill M, McCauley M | title = Psychogenic polydipsia: the result, or cause of, deteriorating psychotic symptoms? A case report of the consequences of water intoxication | journal = Case Reports in Psychiatry | volume = 2015 | pages = 846459 | date = 2015-01-21 | pmid = 25688318 | pmc = 4320790 | doi = 10.1155/2015/846459 | doi-access = free }}</ref>

It has been observed following [[hematopoietic stem cell transplantation]].<ref name="pmid18437020">{{cite journal | vauthors = Lim KH, Kim S, Lee YS, Kim KH, Kim J, Rhee J, Kim HJ, Yi HG, Oh SY, Lim JH, Han SW, Lee S, Kim I, Yoon SS, Park S, Kim BK | display-authors = 6 | title = Central pontine myelinolysis in a patient with acute lymphoblastic leukemia after hematopoietic stem cell transplantation: a case report | journal = Journal of Korean Medical Science | volume = 23 | issue = 2 | pages = 324–327 | date = April 2008 | pmid = 18437020 | pmc = 2526450 | doi = 10.3346/jkms.2008.23.2.324 | url = http://jkms.org/contents/jkms.php?pubyear=2008&vol=23&fpage=324 | url-status = dead | archive-url = https://web.archive.org/web/20090227043351/http://jkms.org/contents/jkms.php?pubyear=2008&vol=23&fpage=324 | archive-date = 2009-02-27 }}</ref>

Central pontine myelinolysis may also occur in patients prone to hyponatremia affected by:
* Severe liver disease (e.g., [[cirrhosis]])
* Liver transplant<ref name="pmid8152365">{{cite journal | vauthors = Singh N, Yu VL, Gayowski T | title = Central nervous system lesions in adult liver transplant recipients: clinical review with implications for management | journal = Medicine | volume = 73 | issue = 2 | pages = 110–118 | date = March 1994 | pmid = 8152365 | doi = 10.1097/00005792-199403000-00004 | s2cid = 37808180 | doi-access = free }}<!--|access-date=2014-05-29--></ref><ref name="pmid11934516">{{cite journal | vauthors = Kato T, Hattori H, Nagato M, Kiuchi T, Uemoto S, Nakahata T, Tanaka K | title = Subclinical central pontine myelinolysis following liver transplantation | journal = Brain & Development | volume = 24 | issue = 3 | pages = 179–182 | date = April 2002 | pmid = 11934516 | doi = 10.1016/S0387-7604(02)00013-X | s2cid = 22140717 }}</ref><ref name="pmid3047544">{{cite journal | vauthors = Martinez AJ, Estol C, Faris AA | title = Neurologic complications of liver transplantation | journal = Neurologic Clinics | volume = 6 | issue = 2 | pages = 327–348 | date = May 1988 | pmid = 3047544 | doi = 10.1016/S0733-8619(18)30873-9 }}<!--|access-date=2014-05-29--></ref>
* [[Alcohol use disorder|Alcoholism]]
* [[Hypokalemia]]
* People with serum sodium <105 mEq/L
* Severe burns<ref name="pmid3399069">{{cite journal | vauthors = McKee AC, Winkelman MD, Banker BQ | title = Central pontine myelinolysis in severely burned patients: relationship to serum hyperosmolality | journal = Neurology | volume = 38 | issue = 8 | pages = 1211–1217 | date = August 1988 | pmid = 3399069 | doi = 10.1212/wnl.38.8.1211 | s2cid = 42068902 }}<!--|access-date=2014-05-29--></ref><ref name="pmid1522803">{{cite journal | vauthors = Winkelman MD, Galloway PG | title = Central nervous system complications of thermal burns. A postmortem study of 139 patients | journal = Medicine | volume = 71 | issue = 5 | pages = 271–283 | date = September 1992 | pmid = 1522803 | doi = 10.1097/00005792-199209000-00002 | s2cid = 12872586 | doi-access = free }}<!--|access-date=2014-05-29--></ref>
* [[Malnutrition]]
* [[Anorexia nervosa]]<ref name="pmid12588925">{{cite journal | vauthors = Sugimoto T, Murata T, Omori M, Wada Y | title = Central pontine myelinolysis associated with hypokalaemia in anorexia nervosa | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 74 | issue = 3 | pages = 353–355 | date = March 2003 | pmid = 12588925 | pmc = 1738317 | doi = 10.1136/jnnp.74.3.353 }}</ref><ref name="pmid15026526">{{cite journal | vauthors = Keswani SC | title = Central pontine myelinolysis associated with hypokalaemia in anorexia nervosa | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 75 | issue = 4 | pages = 663; author reply 663 | date = April 2004 | pmid = 15026526 | pmc = 1739009 }}</ref><ref name="pmid22473289">{{cite journal | vauthors = Leroy S, Gout A, Husson B, de Tournemire R, Tardieu M | title = Centropontine myelinolysis related to refeeding syndrome in an adolescent suffering from anorexia nervosa | journal = Neuropediatrics | volume = 43 | issue = 3 | pages = 152–154 | date = June 2012 | pmid = 22473289 | doi = 10.1055/s-0032-1307458 | s2cid = 22751051 }}</ref>
* Severe electrolyte disorders
* [[HIV/AIDS]]
* [[hyperemesis gravidarum]]<ref name="pmid1393001">{{cite journal | vauthors = Bergin PS, Harvey P | title = Wernicke's encephalopathy and central pontine myelinolysis associated with hyperemesis gravidarum | journal = BMJ | volume = 305 | issue = 6852 | pages = 517–518 | date = August 1992 | pmid = 1393001 | pmc = 1882865 | doi = 10.1136/bmj.305.6852.517 }}</ref><ref name="pmid23546346">{{cite journal | vauthors = Sutamnartpong P, Muengtaweepongsa S, Kulkantrakorn K | title = Wernicke's encephalopathy and central pontine myelinolysis in hyperemesis gravidarum | journal = Journal of Neurosciences in Rural Practice | volume = 4 | issue = 1 | pages = 39–41 | date = January 2013 | pmid = 23546346 | pmc = 3579041 | doi = 10.4103/0976-3147.105608 | doi-access = free }}</ref>
* Hyponatremia due to [[peritoneal dialysis]]
* [[Wernicke encephalopathy]]<ref name="pmid22728498">{{cite journal | vauthors = Kishimoto Y, Ikeda K, Murata K, Kawabe K, Hirayama T, Iwasaki Y | title = Rapid development of central pontine myelinolysis after recovery from Wernicke encephalopathy: a non-alcoholic case without hyponatremia | journal = Internal Medicine | volume = 51 | issue = 12 | pages = 1599–1603 | year = 2012 | pmid = 22728498 | doi = 10.2169/internalmedicine.51.7498 | doi-access = free }}</ref>