Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes

entral pontine myelinolysis (CPM) was described by Adams and colleagues in 1959 as a disease affecting alcoholics and the malnourished. The concept was extended from 1962 with the recognition that lesions can occur outside the pons, so-called extrapontine myelinolysis (EPM). In 1976 a link between these disorders and the rapid correction of sodium in hyponatraemic patients was suggested, and by 1982 substantially established. In this review we discuss the clinical, pathological, and aetiological features of the disease, the dilemma facing clinicians treating patients with severe hyponatraemia, and treatment opportunities.