Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients.

Abstract

In the course of our studies of the neuropathology of alcoholism, which were begun at the Neurological Unit, Boston City Hospital, and have continued in the laboratories of the Neurology Service, Massachusetts General Hospital, two of us (R. D. A. and M. V.) observed three, perhaps four, cases in which the myelin sheaths of all the nerve fibers in the central part of the basis pontis had been destroyed in a single, large, symmetric focus. The nerve cells and axis cylinders were spared for the most part, and the blood vessels were patent and unaffected. There were no signs of inflammation in or near the lesion. The disease had occurred on a background of alcoholism and malnutrition; in the two cases with the largest lesions, it had manifested itself clinically by a pseudobulbar palsy and quadriplegia, leading to death in about 13 and 26 days. In the other two cases