Central Pontine Myelinolysis | Osmotic Demyelination Syndrome

Official Ninja Nerd Website: https://ninjanerd.org Ninja Nerds! In this neuropathology and critical care lecture, Professor Zach Murphy explores central pontine myelinolysis (CPM), also known as Osmotic Demyelination Syndrome (ODS), a devastating demyelinating condition caused by the overly rapid correction of chronic hyponatremia. This lecture bridges neuroanatomy, fluid and electrolyte physiology, and clinical neurology to help you recognize, prevent, and manage this life-threatening complication. We begin by reviewing the underlying pathophysiology, where chronic hyponatremia leads to cerebral adaptation, and rapid sodium correction results in osmotic stress and injury to oligodendrocytes, particularly in the central pons. You’ll learn why patients with chronic alcohol use, liver disease, malnutrition, or transplant history are especially vulnerable. The lecture details the clinical presentation of CPM, which may include dysarthria, dysphagia, quadriplegia, and in severe cases, locked-in syndrome due to damage to corticospinal and corticobulbar tracts in the pons. We also discuss extrapontine manifestations, such as parkinsonism or behavioral changes, which may occur when other brain regions are involved. We walk through safe correction strategies for chronic hyponatremia, emphasizing the importance of limiting sodium correction to less than 8–10 mEq/L in 24 hours and using desmopressin and D5W to re-lower serum sodium if overcorrection occurs. MRI supports diagnosis, revealing demyelination in the central pons, which often lags behind clinical symptoms. Enjoy the lecture and support us below! Table of Contents: 0:00 Lab 0:26 Etiology and Pathophysiology 12:05 Clinical Features 21:55 Diagnosis 26:28 Treatment 30:17 Prevention 31:20 Comment, Like, SUBSCRIBE! 🌐 Official Links Website: https://www.ninjanerd.org Podcast: https://podcast.ninjanerd.org Store: https://merch.ninjanerd.org 📱 Social Media   / ninjanerdlectures     / ninjanerdlectures     / ninjanerdlectures   https://x.com/ninjanerdsci/   / ninja-nerd   💬 Join Our Community Discord:   / discord   #ninjanerd #centralpontinemyelinolysis #osmoticdemyelinationsyndrome