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Zentrale pontine Myelinolyse Morphologie und forensische Bedeutung

Central pontine myelinosis: its morphology and forensic significance

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Summary

Central pontine myelinolysis (CPM) evidently occurs more frequently than had been assumed up to now owing to the cases that have been substantiated solely on the basis of pathological anatomy. Its genesis is still unclarified. Computed tomography and magnetic resonance methods allow detection of the foci while the affected person is still alive. They are clearly capable of regression and are not automatically accompanied by a poor prognosis. Since an iatrogenic factor (forced compensation of hyponatremia) is increasingly under discussion as the cause of CPM, the condition also has substantial significance from a forensic point of view. On the basis of a prospective study on CPM confirmed in 100 brains of alcoholics, as well as 4 further cases from the forensic autopsy material, it is shown that hyponatremia is not likely to be the sole triggering factor. The course of the condition in the cases investigated shows that the capacity for action may be preserved up to death (which has occurred for other reasons) in not very pronounced CPM. In questionable violent and other unclear deaths, CPM must also be considered a possible cause of death. The various hypotheses on its etiology in the extensive literature are compared with the findings in our own cases and discussed.

Zusammenfassung

Die zentrale pontine Myelinolyse (ZPM) kommt offenkundig häufiger vor als bisher aufgrund der allein pathologisch-anatomisch gesicherten Fälle anzunehmen war, ihre Genese ist nach wie vor ungeklärt. Computer-Tomographie und Magnet-Resonanz-Verfahren lassen die Herde bereits zu Lebzeiten erkennen, die offenkundig rückbildungsfähig sind und nicht mit einer infausten Prognose einhergehen müssen. Da zunehmend ein iatrogener Faktor (forcierte Bilanzierung einer Hyponatriämie) als auslösende Ursache diskutiert wird, kommt der Erkrankung auch aus forensischer Sicht eine nicht zu unterschätzende Bedeutung zu. Anhand einer bei prospektiver Untersuchung von 100 Alkoholikergehirnen gesicherten ZPM sowie 4 weiteren Fällen aus dem forensischen Sektionsgut wird aufgezeigt, daß eine Hyponatriämie als alleiniger auslösender Faktor wohl nicht in Betracht kommt. Der Ablauf in den untersuchten Fällen zeigt, daß die Handlungsfähigkeit bei nicht sehr ausgeprägter ZPM bis zum (aus anderer Ursache erfolgten) Tod erhalten sein kann. Bei fraglichen gewaltsamen und anderen unklaren Todesfällen muß auch an eine zentrale pontine Myelinolyse als Todesursache gedacht werden. Aus der umfangreichen Literatur werden die verschiedenen Hypothesen zur Genese den Befunden in den eigenen Fällen gegenübergestellt und diskutiert.

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Authors and Affiliations

  1. Institut für Rechtsmedizin der Ludwig-Maximilians-Universität München, Frauenlobstrasse 7a, D-8000, München 2, Germany

    Hansjürgen Bratzke & Karin Neumann

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  1. Hansjürgen Bratzke
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  2. Karin Neumann
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Herrn Professor Rainer Henn zum 60. Geburtstag gewidmet

Erweiterte Fassung eines Vortrages anläßlich der 65. Jahrestagung der Deutschen Gesellschaft für Rechtsmedizin, St. Gallen, 9.–13.9.1986

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Bratzke, H., Neumann, K. Zentrale pontine Myelinolyse Morphologie und forensische Bedeutung. Z Rechtsmed 102, 79–97 (1989). https://doi.org/10.1007/BF00200502

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