Central pontine myelinolysis

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Central nervous system

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Central pontine myelinolysis

• Weakness in the face, arms, or legs, usually affecting both sides of the body
• Muscle spasms in the face, arms, or legs
• Double vision
• Reduced vision
• Confusion, delirium
• Speech changes, poor enunciation
• Difficulty swallowing
• Reduced alertness, drowsy or sleepy, lethargic, poorly responsive

• Hand tremor
• Hallucinations
• Eyes -- pupils different size
• Uncontrollable eye movements
• Constipation

An examination may indicate involvement of all four arms and legs (spastic quadriplegia) or weakness of the face, arms, and legs (upper motor neuron syndromes). Reflexes may be abnormal. An eye examination may show loss of control of eye muscles, particularly cranial nerve VI paralysis (see cranial mononeuropathy VI).

A head MRI scan would reveal an abnormality in the brainstem (pons). This is the main diagnostic test.

Other tests may include:

• Blood sodium levels and other blood tests
• Brainstem evoked response audiometry (BERA)

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