Evolution of central pontine myelinolysis on CT.

Central pontine myelinolysis (CPM) was first described by Adams et al. [1] in 1959; since then, well over 100 cases have been reported. The disease has been noted predominantly in alcoholics with electrolyte imbalances, usually hyponatremia, most especially after electrolyte derangement has been rapidly reversed by vigorous intravenous fluid administration . The characteristic clinical course includes initial neurologic improvement paralleling electrolyte correction and subsequent deterioration, including quadriparesis and pseudobulbar signs. Diagnosis has generally been made on the basis of autopsy material. Before computed tomography (CT), there was no radiologic method for detection. CT findings in CPM have sometimes been reported as negative, but, in a few cases , large pontine hypodense lesions have been uncovered. The following case demonstrates the evolution of these lucencies over the course of hospitalization.