An autopsied case of recent ischemic and hemorrhagic
necrosis of the pons is reported, in which the anatomical site of the lesion is similar to that observed in
central pontine myelinolysis. The patient, a 46-year-old woman, was a chronic alcoholic who had been treated with large quantities of physiological saline and
glucose solution at 5% during a period of nine days before death. On the fifth day of treatment she developed
hypernatremia, which persisted for three days. From
hyperglycemia on the day of admission, her serum
glucose levels subsequently dropped to normal values and then rose again on the day of death. Examination of the brain revealed recent ischemic and hemorrhagic
necrosis affecting the central portion of the upper two thirds of the pontine basis, in triangular, bilaterally symmetrical pattern, and extending into the tegmentum. There was no evidence of
demyelination or degradation products of the myelin. No vascular alterations or thrombi were identified in the pontine vessels surrounding the lesion. The differential diagnosis of pontine
infarct,
central pontine myelinolysis, and Duret's
hemorrhage is discussed. In analysing the possible etiology and pathogenesis of the lesion, it is suggested that osmotic
vascular injuries induced by fluctuating levels of serum
sodium and
glucose may lead to
edema and
demyelination similar to that observed in
central pontine myelinolysis and, rarely, to
necrosis and
hemorrhage, as in the present case.