Pseudobulbar palsy

Treatment of hyponatremia involves the use of hypertonic saline. However, care is required since correction at rates in excess of 1 mEq/l/h may result in central pontine myelinolysis (CPM) [5], Symptoms of CPM include progressive weakness leading to quadriparesis, pseudobulbar palsy and altered mental status. CPM is often fatal and is characterized neuropathologically by demyelinating lesions in the central pons. 

First clinical manifestations appear after puberty, between the 15th and 25th years of life. They consist mainly of symptoms of mental involution. Neurologic signs result from involvement of the extrapyramidal system, in addition, cerebral seizures are observed. Visual disturbances, pigmentary retinitis and optic atrophy occur rarely, and blindness does not develop. The disease runs a chronic course, which may last for decades and end up with the picture of pseudobulbar palsy or marasm. 

Along with hypoventilation, these alterations represent the most important problem from the patient s point of view (29). Severe bulbar dysfimetion and glottie dysfunction most commonly occur in patients with amyotrophie lateral selerosis (ALS), spinal muscle atrophy type 1, and the pseudobulbar palsy of eentral nervous system etiology (30). Inability to elose the glottis and vocal cords results in eomplete loss of the ability to cough and swallow. 

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