Central pontine myelinolysis

Over-rapid correction of the sodium concentration by whatever means must be avoided, as this can result in a severe, neurological syndrome due to local areas of demyelination, called central pontine myelinolysis or the osmotic demyelination syndrome. Features of this include quadriparesis, respiratory arrest, pseudobulbar palsy, mutism, and, rarely, fits. The distribution of the areas of demyelination include most often the pons, but also, in some cases, the basal ganglia, internal capsule, lateral geniculate body and even the cerebral cortex. Diagnosis is by characteristic appearances on brain MRI.