Central pontine myelinolysis – causes, symptoms & treatment

Zentrale pontine Myelinolyse

Central pontine myelinolysis is a brain disorder. It’s a neurological condition. It involves damage to nerve fibers.

What is central pontine myelinolysis?

Central pontine myelinolysis is a rare disease of the nerve fibers in the brain. The sheathing of the nerves is damaged and leads to discomfort. The word “pontine” is derived from the “pons”. These are located in the brain and are part of the brainstem there.

The pons are located between the medulla oblongata , also known as the elongated spinal cord, and the midbrain. If you look sideways at the head, they are located approximately behind the ears. In the pons, the information from the inner auditory canal and the facial area is recorded and sent to the cerebellum. Forwarded to the cerebellum.

The information received from the sensors is transported via the nerve fibers in this region. Nerves may be encased. This is called myelination. Myelination causes the electrical signals to remain within the nerve fiber and can be transported to the target site more quickly.

Without the sheath, the signals would migrate to the vicinity of the nerve tract. This leads to a reduction in the signal. Central pontine myelinolysis causes the protection of the sheath to be reduced or even lost entirely through damage.


The causes of central pontine myelinolysis include all diseases or disorders that are associated with a change in the concentration of sodium in the organism. This is usually what is known as hyponatremia . This is an electrolyte imbalance that causes sodium deficiency.

If this state of sodium deficiency lasts longer, central pontine myelinolysis occurs via hyponatremia. The causes of hyponatremia are different. They range from eating disorders and hormone disorders to alcoholism and side effects of medication. In addition, the disease can occur with incorrect infusion therapy. Eating disorders such as anorexia often involve a low-salt diet.

At the same time, sufferers consume large amounts of liquids, which in turn result in sodium being excreted. Malnutrition and anorexia are characterized by a long course of the disease, so there can be a lack of sodium in the blood. The same applies to alcoholism. Malnutrition also occurs as the disease progresses. This results in the sufferer missing out on important amounts of minerals.

Symptoms, Ailments & Signs

Central pontine myelinolysis leads to damage to the nerves in the pons region. This limits their functionality. Signals are passed more slowly or do not reach the organ that can identify and process them.

The damage to the nerve fibers leads to discomfort and pain in the head area at ear level. Disorders or loss of consciousness can occur. Disorientation and confusion are perceived in patients with central pontine myelinolysis .

In severe cases, patients experience a comatose state . Brainstem function is impaired in central pontine myelinolysis. This results in circulatory disorders and associated functional disorders of the brainstem. There are disturbances in eye movements and swallowing processes .

In some cases there are problems with language formation . The articulation changes and the patient has difficulties with voice formation. In addition, patients show uncertainties in their gait . Paralysis or partial paralysis of the face occurs in some patients . In addition, respiratory paralysis may occur. This is a life threatening situation.

Diagnosis & disease progression

In the course of the disease there is the possibility of a life-threatening condition. If the condition is properly treated, full recovery can occur. However, full recovery of all the symptoms that have arisen is not always given.

The diagnosis is given after ascertaining other diseases and using imaging methods such as magnetic resonance therapy. If the body is supplied with sufficient sodium, there will be an improvement. The healing period is estimated to be anywhere from two weeks to a year.


If central pontine myelinolysis is correctly diagnosed and treated in good time, there are usually no serious complications to be feared. Since this disease is very rare, it is often not recognized or only recognized very late. The disease can then take a severe course, in which the typical symptoms, especially pain in the ear area as well as disorientation and confusion, occur more frequently.

The function of the brainstem can be restricted due to circulatory disorders. This can affect the speech center and language formation. The patient then often has difficulties forming certain sounds, and the vocal pattern often changes.

Problems with swallowing and a resulting impairment in food intake are also conceivable. Other possible complications are balance disorders, which lead to an unsteady gait, and paralysis in the facial area. If there is also paralysis of breathing, the patient’s life is in acute danger.

In very severe cases, it also happens that patients fall into a coma. A rare but repeatedly documented complication is the so-called locked-in syndrome. In this case, there is a complete paralysis of all limbs, as well as the speech apparatus. Those affected can usually only communicate with their environment by blinking, although they are mentally fully conscious.

When should you go to the doctor?

Disorders of eating behavior or excessive consumption of alcohol should always lead to the affected person seeking medical help. Especially with an increase in destructive behavior, there is a risk of health problems that should be counteracted in good time. In the case of disorientation, cognitive disorders and irregularities in blood circulation, a doctor’s visit is necessary. Speech problems, unsteady gait, reduced performance or states of confusion must be examined and treated by a doctor.

Changes in personality, abnormal behavior and irregularities in memory are warning signals that must be investigated as soon as possible. In acute cases, the person concerned requires intensive medical care. Therefore, a doctor should be consulted at an early stage in the event of disorders of consciousness. If there is a loss of consciousness, an emergency service must be alerted. Irregularities in eye movements and abnormalities in the act of swallowing should also be examined.

The affected person needs help as soon as possible as soon as paralysis or other loss of muscle activity occurs. If left untreated or in an advanced stage of the disease, a life-threatening situation can develop. It is therefore advisable to seek the cooperation of a doctor as soon as the first deterioration in the general state of health occurs. Lifestyle changes are necessary so that complications or serious illnesses can be averted as early as possible. In addition, irreparable damage to the organism can occur in an advanced stage of the disease.

Treatment & Therapy

A spontaneous healing of the central pontine myelinolysis is not known. Even if the sodium level in the blood is at a recommended level, damage to the nerve sheathing is still present. Still, with the right treatment, full recovery can occur.

The process of regeneration takes several months, although in the case of chronic hyponatremia it cannot be assumed that the damage will disappear. For this reason, the symptoms that occur are the focus of therapy when treating central pontine myelinolysis.

In addition, the sodium content in the blood is measured at short intervals and the intake of sodium is closely monitored. If the patient suffers from paralysis in an individual area of ​​the face, this is treated with targeted physiotherapy and appropriate exercises.

If the signs of paralysis occur in the area of ​​breathing, the patient is artificially ventilated. A tracheostomy is performed if the patient has difficulty swallowing . This is an incision in the trachea used to gain access to the windpipe.


As a preventive measure, the sodium content is measured and controlled by regularly checking the blood. The level of sodium in the blood should not be less than 126 mmol/l. In addition, food intake can be used to ensure that the body is regularly and sufficiently supplied with minerals containing salt. This can be done with food or liquids.


People who suffer or have suffered from the condition should make significant lifestyle changes. Since the disease is based on disturbed eating habits, those affected should constantly monitor and adjust their diet. However, if there is still malnutrition, the organism of those affected must be supplied with sufficient vitamins and nutrients.

In order to achieve lasting relief from the symptoms, a balanced and, above all, healthy diet is very important for those affected. Since the disease often means a great deal of stress, it is advisable to undergo permanent psychological counselling. Many of those affected are often emotionally unstable and cannot cope with the disease on their own and thus achieve an improvement.

For this reason, it could also be helpful for those affected to join a self-help group. There, new methods can be learned that should make it easier to deal with the disease. Those affected can also talk to other sufferers about the disease there and thus do not feel left alone. Contact with family and loved ones is also important.

The support makes it easier for those affected to cope with the disease and to find a way out. The regularly scheduled visits to the doctor are mandatory for those affected. Those affected should refrain from consuming alcohol or nicotine.

You can do that yourself

People suffering from central pontine myelinolysis need to review their lifestyle and show a willingness to make changes. The causes of the disease can often be based on eating disorders or addictive behavior. Therefore, the diet should be controlled and should be optimized if possible. If there is malnutrition, sufficient nutrients and vitamins must be supplied to the organism. A balanced and healthy diet is particularly important for patients in order to alleviate their symptoms.

Parallel psychological support is helpful in many cases . Patients with this disease are often unable to bring about a lasting and stable improvement in their living situation on their own. It is therefore advisable to seek adequate help. Patients should show willingness to change and work cooperatively with medical professionals or professionals. Honesty and the creation of a basis of trust between patient and doctor are of particular importance. The consumption of alcohol or non-prescribed medication is not permitted. Sufficient liquid should be consumed and phases of rest and recovery should be taken regularly.

It can also be helpful if the options offered for regular health checks are accepted. In this way, changes in health can be analyzed quickly and measures for improvement can be initiated immediately.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.