Central pontine myelinolysis with extrapontine lesions

[Central pontine myelosis. Morphology and forensic importance]

Central pontine myelinolysis (CPM) evidently occurs more frequently than had been assumed up to now owing to the cases that have been substantiated solely on the basis of pathological anatomy. Its genesis is still unclarified. Computed tomography and magnetic resonance methods allow detection of the foci while the affected person is still alive. They are clearly capable of regression and are not automatically accompanied by a poor prognosis. Since an iatrogenic factor (forced compensation of hyponatremia) is increasingly under discussion as the cause of CPM, the condition also has substantial significance from a forensic point of view. On the basis of a prospective study on CPM confirmed in 100 brains of alcoholics, as well as 4 further cases from the forensic autopsy material, it is shown that hyponatremia is not likely to be the sole triggering factor. The course of the condition in the cases investigated shows that the capacity for action may be preserved up to death (which has occurred for other reasons) in not very pronounced CPM. In questionable violent and other unclear deaths, CPM must also be considered a possible cause of death. The various hypotheses on its etiology in the extensive literature are compared with the findings in our own cases and discussed.