Pontine hemorrhage at a microbleed site in a patient with central pontine myelinolysis

Abstract

Central pontine myelinolysis (CPM) is an uncommon disorder, characterized by non-inflammatory demyelination, which may be caused by an abrupt change of serum osmolarity, especially of sodium concentration. Although rapid correction of chronic hyponatremia leads to the disruption of the blood–brain-barrier (BBB), CPM associated with intracerebral hemorrhage (ICH) has rarely been reported. Cerebral microbleed (CMB) is a 2–5-mm sized small hypointense lesion that is generally detected by gradient echo (GRE) magnetic resonance imaging (MRI), which is thought to be associated with advanced microangiopathy, focal breakdown of the BBB and risk of bleeding. In view of the possible effects of CPM and CMB on the BBB, we can postulate that the affected region is in a hemorrhagic-prone state. We describe a patient who suffered CPM and subsequent ICH at the site of pontine microbleeds