Central Pontine Myelinolysis: The Timing of MRI Finding Is Not Correlated with Clinical Manifestation and Prognosis

Central pontine myelinolysis (CPM) is a dreaded complication from overly rapid correction of hyponatremia. Historically, the prognosis of CPM is dismal. Recent studies showed that improved neurological outcome was possible but reports on improvement in brain imaging are rare. We presented a patient who had not only complete neurologic recovery but also had significant regression on brain magnetic resonance imaging (MRI). In the past, a rise in serum sodium < 12 mEq/L in the first 24 hours was accepted as a safe margin. We now know that an increase in serum sodium concentration by 4-6 mEq/L is enough to overcome the serious neurological complications. When over correction occurs, we could use desmopressin and 5% dextrose solution dextrose solution to lower serum sodium. We should perhaps limit the speed of sodium correction to less than 8 mEq/L in the first 24 hours and allow room for errors. (Acta Nephrologica 2011; 25: 205-208)