618 Klinik Nöropsikoloji ve Nöropsikiyatrik Hastalıklar letarji, hipotansiyon epilektik nöbet, tetraparezi, spastik paraparezi gibi geniş bir yelpazede kendini gösterebilir. Ender bir olguda ‘locked in syndrome’ tanımlanmıştır (Lampl et al., 2002; Choksi et al., 2005). SPM ve EPM da, Parkinson bulguları ile kendini gösteren olgular da bildirilmiştir (Nagamitsu et al., 1999; Sajith et al., 2006). SPM ve EPM’nin sağaltımda önleyici tedbirler üzerinde durulmalıdır. Özellikle, kronik alkol alımı olan, beslenme bozukluğu olan, kronik hiponatremisi olan hastalarda elektrolit dengesizliği saptanması halinde replasman sağaltımı yapılırken uzun süreye yayılmalıdır. Klinik tablonun oluştuğu hastalarda yeterli kalori alınımın sağlanması, antiödem, pnömoni, tromboz ve bası yaralarını önleyici sağaltımlar başlanmalıdır. Tedavide literatürde olgu takdimi şeklinde yayınlarda 4 modalite üzerinde durulmaktadır; trotropin releasing hormon, plazmaferez, kortikosteroid ve steroidle kombine plazmaferezdir (Chemaly et al., 1998; Nishino et al., 1991; Wakui et al., 1991; Finsterer et al., 2000). Prognoz tutalan bölgeye bağlı olarak değişmektedir. Bununla birlikte SPM olgularının çoğunda nörolojik hasarlar kalıcı olmaktadır. Kaynaklar Adams RA, Victor M, Mancall EL. Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients. AMA Arch Neurol Psychiatry 1959;81:154-172 Ashrafian H, Davey P. A review of the causes of central pontine myelinosis: yet another apoptotic illness. Eur J Neurol 2001;8:103-109 Bernsen HJ, Prick MJ. Improvement of central pontine myelinolysis as demonstrated by repeated magnetic resonance imaging in a patient without evidence of hyponatremia. Acta Neurol Belg 1999;99:189-193 Bonham CA, Dominguez EA, Fukui MB, et al. Central nervous system lesions in liver transplant recipients: prospective assessment of indications for biopsy and implications for management. Transplantation 1998;66:15961604 Chemaly R, Halaby G, Mohasseb G, Medlej R, Tamraz J, El-Koussa S. Extrapontine myelinolysis treatment with TRH. Rev Neurol 1998;154:163-165 Choksi R, Roach SE. Ring-enhancing lesion in central pontine myelinolysis. Arch Neurol 2005;62:1016-1017 Finsterer J, Engelmayer E, Trinka E, Stiskal M. Immunoglobulins are effective in pontine myelinolysis. Clin Neuropharmacol 2000;23:110-113 Fraser C, Charnas L, Orchard P. Central pontine myelinolysis following bone marrow transplantation complicated by severe hepatic veno-occlusion. Bone narrow transplantation 2005;36:733-734 Hagiwara K, Okada Y, Shida N, Yamashita Y. Extensive central and extrapontine myelinolysis in a case of chronic alcoholism without hyponatremia: A case report with analysis of serial MR findings Intern Med 2000;47:431-435 Laitt RD, Thornton M, Goddard P. Pontine myelinolysis in a normonatraemic alcoholic [letter]. Clin Radiol 1993;47:432-433 Lampl C, Yazdi K. Central pontine myelinolysis. Eur Neurol 2002;47:3-10 Mascalchi M, Cincotto M, Piazzini M. Case report. MRI demonstration of pontine and thalamic mylelinolysis in a normonatremic alcoholic. Clin Radio 1993;47:137-138 McKee AC, Winkelman MD, Banker BQ. Central pontine myelinolysis in severely burned patients: relationship to serum hyperosmolality [published erratum appears in Neurology 1988;38:1662]. Neurology 1988;38:1211-1217 Miller RF, Harrison MJ, Hall-Craggs MA, Scaravilli F. Central pontine myelinolysis in AIDS. Acta Neuropathol (Berl) 1998;96:537-540 Musana KA, Yale SH. Central pontine myelinolysis case series and review. Wilsonsin Med J 2002;104:56-60 Nagamitsu S, Matsusishi T, Yamashita Y, et al. Extrapontine myelinolysis with parkinsonism after rapid correction of hyponatremia: high cerebrospinal fluid level of homovanillic acid and successful treatment. J Neural Transm 1999:106;949-953 Nishino K, Yasuda T, Kowoda M. A case of central pontine myelinolysis with neurological recovery after administration of glucocorticoid. No To Shinkei 1991;43:483-488 Sajith J, Ditchfield A, Katifi HA. Extrapontine myelinolysis presenting as acute parkinsonism BMC. Neurology 2006;6:33 Tomlinson BE, Pierides AM, Bradley WG. Central pontine myelinolysis. Two cases with associated electrolyte disturbance. QJ Med 1976;45:373-386 Wakui H, Nishimura S, Watahiki Y, et al. Dramatic recovery from neurological deficits in a patient with central pontine myelinolysis following severe hyponatremia. Jpn J Med 1991;30:281-284