Central pontine myelinolysis

Symptoms:

• weakness in the face, arms, or legs
  • usually affecting both sides of the body

• muscle spasms in the face, arms, and/or legs
• double vision
• reduced vision
• confusion, delirium
• speech changes, poor enunciation
• difficulty swallowing
• reduced alertness
  • drowsy, sleepy, lethargic
  • poorly responsive

Additional symptoms that may be associated with this disease:

• hand tremor
• hallucinations
• eyes, pupils different size
• eye movements, uncontrollable
• constipation

Signs and tests:

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

A cranial MRI scan shows abnormality in the brainstem (pons). This is the primary diagnostic study.

Other procedures:

• CT scan of the head shows a lesion in the pons.
• Brainstem evoked response audiometry (BERA) is abnormal.

This disease may also alter the results of the following tests:

• nerve biopsy
• nerve conduction velocity