Central pontine myelinolysis in the presence of SARS-CoV-2 infection (clinical observations)

 Osmotic demyelinating syndrome (ODS) is a severe complication that occurs due to rapid correction of hyponatremia. Central  pontine myelinolysis (CPM), in which a focus of demyelination  occurs in the pontine region, and extrapontine myelinolysis (EPM),  in which foci of demyelination appear in the white matter of the  cerebral hemispheres, can be distinguished as a part of this  syndrome. We describe two clinical cases of CPM that developed due to hyponatremia and hypokalemia in patients with SARS-CoV-2 infection (COVID-19). Differential diagnosis included acute  disseminated encephalomyelitis, infectious encephalitis, and brain  tumor. In both cases, a significant recovery of the lost functions was noted. The pathogenetic mechanisms of CPM development in  patients with COVID-19 are discussed. ODS development in COVID- 19 necessitates strict control and correction of electrolyte  disturbances in this category of patients in accordance with existing  recommendations, which can reduce the risk of CPM. 

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