1. Extrapontine Myelinolysis extrapontine myelinolysis. Findings Differential Diagnosis centralpontine/extrapontine myelinolysis, ADEM, MS less likely. Discussion http://www.med.uc.edu/neurorad/webpage/ffa.html

Extrapontine Myelinolysis Findings: Axial CT images with and without contrast demonstrate patchy areas of symmetric low attenuation in the pons, thalami, and basal ganglia, without enhancement. Differential Diagnosis: central pontine/extrapontine myelinolysis, ADEM, MS less likely Discussion: Central pontine myelinolysis occurs infrequently when electrolyte disorders are corrected too quickly, and manifests clinically as spastic paraparesis, pseudobulbar palsy, or "locked in" syndrome. While the majority of cases are caused by rapid correction of hyponatremia or associated with alcoholism, a variety of electrolyte and metabolic disorders may have a role in CPM. Characteristic imaging features include symmetric hypodensity or signal abnormality in the pontine transverse fibers. These attenuation abnormalities can extend into the deep gray structures in up to 50%. BACK TO UNKNOWNS BACK TO CATEGORIES HOME

2. EMedicine - Central Pontine Myelinolysis : Article By Christopher C Luzzio, MD Central Pontine Myelinolysis Adams et al described central pontine myelinolysis (CPM) as a unique clinical entity. They published their findings in 1958, observing that patients who suffered than "central pontine myelinolysis" for demyelination occurring in extrapontine regions after the Laureno R Pontine and extrapontine myelinolysis a neurologic disorder following http://www.emedicine.com/neuro/topic50.htm

(advertisement) Home Specialties Resource Centers CME ... Patient Education Articles Images CME Patient Education Advanced Search Consumer Health Link to this site Back to: eMedicine Specialties Neurology Neurotoxicology Central Pontine Myelinolysis Last Updated: March 12, 2001 Rate this Article Email to a Colleague Synonyms and related keywords: osmotic myelinolysis AUTHOR INFORMATION Section 1 of 9 Author Information Introduction Clinical Differentials ... Bibliography Author: Christopher C Luzzio, MD , Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison Christopher C Luzzio, MD, is a member of the following medical societies: American Academy of Neurology Editor(s): Howard A Crystal, MD , Professor, Departments of Neurology and Pathology, State University of New York Downstate; Francisco Talavera, PharmD, PhD , Senior Pharmacy Editor, Pharmacy, eMedicine; Richard J Caselli, MD , Chairperson, Department of Neurology, Professor, Department of Neurology, Mayo Clinic of Scottsdale; Selim R Benbadis, MD

3. Ann Intern Med -- Abstracts: Laureno And Karp 126 (1): 57 known to also affect extrapontinebrain areas. Manifestations of myelinolysis usually evolve severaldays Catatonia due to central pontine and extrapontine myelinolysis case report http://www.annals.org/cgi/content/abstract/126/1/57

Search Annals: Advanced search Home Current Issue Past Issues ... ACP Online Article Table of Contents Full Text of this article Figures/Tables List Services Send comment/rapid response letter Notify a friend about this article Alert me when this article is cited Add to Personal Archive New Download to Citation Manager ACP Search PubMed Articles in PubMed by Author: Laureno, R. Karp, B. I. Related Articles in PubMed PubMed Citation ... PubMed UPDATE Myelinolysis after Correction of Hyponatremia Robert Laureno, MD and Barbara Illowsky Karp, MD Myelinolysis is a neurologic disorder that can occur after rapid correction of hyponatremia.Initially named "central pontine myelinolysis," this disease is now known to also affect extrapontine brain areas. Manifestations of myelinolysis usually evolve several days after correction of hyponatremia. Typical features are disorders of upper motor neurons, spastic quadriparesis and pseudobulbar palsy, and mental disorders ranging from mild confusion to coma. Death may occur. The motor and localizing signs of myelinolysis differ from the generalized encephalopathy that is caused by untreated hyponatremia.

4. Ann Intern Med -- Karp And Laureno 127 (2): 163 amasseddata showing that rapid correction of hyponatremia may causemyelinolysis. Pontine and extrapontine myelinolysis. A neurological disorder following rapid correction of http://www.annals.org/cgi/content/full/127/2/163-a

Search Annals: Advanced search Home Current Issue Past Issues ... ACP Online Article Table of Contents Services Send comment/rapid response letter Notify a friend about this article Alert me when this article is cited Add to Personal Archive New Download to Citation Manager ACP Search PubMed Articles in PubMed by Author: Karp, B. I. Laureno, R. PubMed REPLY Reply Hyponatremia and Myelinolysis Barbara I. Karp, MD and Robert Laureno, MD IN RESPONSE Rapid correction of hyponatremia can cause myelinolysis. This iatrogenic illness has been well documented in humans and in controlled experiments in three mammalian species Drs. Ayus and Arieff state that the rate of correction of plasma sodium concentration is "irrelevant," yet they warn that a rate of correction of "more than 25 mmol/L in 48 hours can lead to cerebral demyelinating lesions." These statements are contradictory. The authors then discuss one possible outcome of symptomatic hyponatremia. We have always recognized that neurologic complications are associated with both hyponatremia and its correction. We hope that Drs. Ayus and Arieff will soon recognize the amassed

5. Files2 laryngocele dural fibrosis after shunt placement -Wernicke s syndrome -Adrenoleukodystrophy-Leigh Disease -extrapontine myelinolysis -langerhans cell http://www.med.uc.edu/neurorad/webpage/files2.html

Teaching Files -asterisk indicates numerous images to load- suggested for high speed connections only unless you are willing to wait. -last update: 2 Mar 00 -Vascular ACA aneurysm delayed L MCA aneurysm rupture L ICA aneurysm, initial neg angio SDH with PCOM aneurysm ... spinal DAVF -Inflammatory/Infectious herpes encephalitis abscess toxoplasmosis meningitis with mastoiditis ... cryptococcosis -Neoplastic -intraaxial hemangioblastoma subependymoma GBM glioma/gliomatosis cerebri ... germinoma -extraaxial chordoma ependymoma pineocytoma carotid body tumor ... ewing sarcoma -sellar pituitary adenoma -other neoplasms amelanotic melanoma orbital lymphoma chondrosarcoma rhabdomyosarcoma ... pleomorphic adenoma -Congenital lissencephaly schizencephaly open schizencephaly hemimegalencephaly ... ectopic neurohypophysis -Trauma skull fxs dissection with acute stroke shear multiple injuries ... EDH -Degenerative/Metabolic/Other CO poisoning mitochondrial disorder superficial siderosis1 superficial siderosis2 ... mesial temporal sclerosis Digital images contributed by Drs. Ernst, Gaskill, Leach, Tomsick, Claar, and fellows. The viewer is solely responsible for verification of the information presented. Diagnosis given is considered to be the most likely but not the only consideration for each case, and no claims are made of the validity of an individual diagnosis or of the information presented. In general, references are not listed since the concepts are those found in standard reference texts and the reader is encouraged to compare this information with his/her own knowledge resources.

6. Myelinolysis, Central Pontine Myelinolysis, Central Pontine Medical.WebEnds.com Myelinolysis; extrapontine myelinolysis; Extrapontine Myelinoclasis; Myelinoclasis, Central Pontine; Pontine Myelinolysis Extrapontine Myelinoclases; Extrapontine Myelinolyses http://medical.webends.com/index.php?id=15150

7. Entrez PubMed Pontine and extrapontine myelinolysis a neurologic disorder followingrapid correction of hyponatremia. Karp BI, Laureno R. National http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstra

8. Myelinolysis documed Demyelinating diseases Myelinolysis. Clinical features. Parkinsonism and dystonia in central pontine and extrapontine myelinolysis J Neurol Neurosurg Psychiatry 1998 Jul;65(1)11921 Case http://rkaris.home.att.net/cpm.htm

documed Demyelinating diseases : Myelinolysis Clinical features Parkinsonism and dystonia in central pontine and extrapontine myelinolysis J Neurol Neurosurg Psychiatry 1998 Jul;65(1):119-21 Case report. Abnormal movements in a case of extrapontine myelinolysis. Review of the literature. Rev Neurol 1998 Feb;26(150):215-20 [chorea, dystonia, Parkinsonism] Central pontine myelinolysis: clinical presentation and radiologic findings Eur Radiol 1996;6(2):177-83 [The symptoms ranged from severe neurologic disorders to mild neurologic disturbances only. The size of the pontine lesion did not correlate with the severity of the neurologic illness or the final outcome.] Regressive dystonia and cerebellar ataxia: two unusual symptoms in central pontine myelinolysis J Neurol 1995 Jul;242(7):450-4 Central pontine myelinolysis with cerebellar ataxia and dystonia Rev Neurol (Paris) 1993;149(5):344-6 Electrolytes Central pontine myelinolysis: clinical syndrome with normal serum sodium Eur J Med Res 1995 Dec 18;1(3):168-70 Case report. Myelinolysis after correction of hyponatremia Ann Intern Med 1997 Jan 1;126(1):57-62

9. Entrez PubMed Abnormal movements in a case of extrapontine myelinolysis. Reviewof the literature Article in Spanish Ezpeleta D, de Andres http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9

10. Pontine And Extrapontine Myelinolysis A Neurologic Disorder HighBeam Research, Free Preview 'Pontine and extrapontine myelinolysis a neurologic disorder following rapid correction of hyponatremia.' Full Membership required for unlimited access. The http://rdre1.inktomi.com/click?u=http://www.highbeam.com/library/doc0.asp?docid=

11. Pontine And Extrapontine Myelinolysis Following Rapid Correction Of Hyponatremia Click on image for details. Year 2000 Volume 48 Issue 1 Page 97. Pontineand extrapontine myelinolysis following rapid correction of hyponatremia. http://www.neurologyindia.com/article.asp?issn=0028-3886;year=2000;volume=48;iss

12. Pontine And Extrapontine Myelinolysis Following Rapid Correction Of Hyponatremia Year 2000 Volume 48 Issue 1 Page 97. Pontine and extrapontinemyelinolysis following rapid correction of hyponatremia. http://www.neurologyindia.com/article.asp?issn=0028-3886;year=2000;volume=48;iss

13. AJNR -- Cramer Et Al. 22 (8): 1476 consistent withCPM (4) with extrapontine myelinolysis arising as a result of Pontine and extrapontine myelinolysis a neurologic disorder following rapid correction of hyponatremia http://www.ajnr.org/cgi/content/full/22/8/1476

HOME HELP FEEDBACK SUBSCRIPTIONS ... TABLE OF CONTENTS QUICK SEARCH: [advanced] Author: Keyword(s): Year: Vol: Page: Abstract of this Article Figures Only for this Article PDF Version of this Article Citation Map Similar articles found in: AJNR Online PubMed PubMed Citation This Article has been cited by: other online articles Search PubMed for articles by: Cramer, S. C. Maravilla, K. R. Alert me when: new articles cite this article Download to Citation Manager American Journal of Neuroradiology American Society of Neuroradiology ARTICLE Decreased Diffusion in Central Pontine Myelinolysis Steven C. Cramer a Keith C. Stegbauer a Alex Schneider a John Mukai a and Kenneth R. Maravilla a a From the Departments of Neurology (S.C.C., A.S.), Bioengineering (K.C.S.), and Radiology (K.R.M.), University of Washington, Seattle, WA, and Kennewick General Hospital (J.M.), Kennewick, WA. Abstract TOP Abstract Introduction Case Reports Discussion References Summary: Two patients with central pontine myelinolysis (CPM) were studied with diffusion-weighted MR imaging 1 week after onset of tetraplegia. In both patients, affected white matter

14. Extrapontine Myelinolysis : On Medical Dictionary Online extrapontine myelinolysis defined on the Free Online Medical Dictionary. Linkto the Medical Dictionary Online. extrapontine myelinolysis. http://www.online-medical-dictionary.org/?q=Extrapontine Myelinolysis

15. Ex : On Medical Dictionary Online Extraordinary Treatments Extrapontine Myelinoclases Extrapontine MyelinoclasisExtrapontine Myelinolyses extrapontine myelinolysis Extrapyramidal Disorder http://www.online-medical-dictionary.org/?q=~Ex

16. JCEM -- Maghnie Et Al. 82 (6): 1749 Hyatrogenic extrapontine myelinolysis in Central Diabetes Insipidus Are Cyclosporine and 1 1988 Pontine and extrapontine myelinolysis following rapid correction of hyponatremia http://intl-jcem.endojournals.org/cgi/content/full/82/6/1749

HOME HELP FEEDBACK SUBSCRIPTIONS ... Citation Map Similar articles found in: JCEM Online PubMed PubMed Citation Search PubMed for articles by: Maghnie, M. Alert me when: new articles cite this article Download to Citation Manager Special Articles Hyatrogenic Extrapontine Myelinolysis in Central Diabetes Insipidus: Are Cyclosporine and 1-Desamino-8- D -Arginine Vasopressin Harmful in Association? Mohamad Maghnie Eugenio Genovese Stefan Lundin Federico Bonetti and Departments of Pediatrics (M.M., F.B., M.A.), Radiology (E.G.), University of Pavia, IRCCS Policlinico S. Matteo, Pavia, Italy; Department of Clinical Pharmacology (S.L.), Lund University Hospital, Lund, Sweden Address all correspondence and requests for reprints to: Mohamad Maghnie, Department of Pediatrics, University of Pavia, IRCCS Policlinico S.Matteo, 27100 Pavia. Italy. E-mail aricom@ipv36.unipv.it. Introduction Top Introduction DDAVP kinetics Differential diagnosis and... References cell histiocytosis (LCH) affecting bone, skin, and lung, lymphadenomegaly, and hepatosplenomegaly. She was repeatedly treated with chemotherapy

17. Syndrome Of Inappropriate ADH Pontine and extrapontine myelinolysis a neurologic disorder following rapid correction of lesions (central pontine or extrapontine myelinolysis) with major disability or fatal http://www.thedoctorsdoctor.com/diseases/siadh.htm

Background SIADH stands for syndrome of inappropriate anti-diuretic hormone. The abnormal production of this hormone ADH, leads to salt wasting, or hyponatremia. The result is a profound metabolic disturbance which may result in coma and death. The pathologist is often called upon to investigate a laboratory abnormality of serum hypo-osmolality, an unexpectedly high urinary specific gravity, an absence of edema or dehydration, hyponatremia, and an elevation of plasma vasopressin. Usually there is normal adrenal, thyroid, and renal function. Occasionally the syndrome is due to head trauma or a tumor. In these cases, the pathologist may be called upon to evaluate a tissue biopsy to confirm the diagnosis. OUTLINE Epidemiology Amiodarone Psychotropic drugs Vincristine Disease Associations Head and neck cancer Lung cancer Pneumonia Laboratory/Radiologic/Other Diagnostic Testing Gross Appearance and Clinical Variants Geriatric Differential Diagnosis Cerebral salt wasting syndrome Prognosis Central pontine myelinolysis Treatment Vasopressin Receptor Antagonist Commonly Used Terms Internet Links EPIDEMIOLOGY CHARACTERIZATION SYNONYMS Schwartz-Bartter syndrome INCIDENCE/PREVALENCE Probably more common than reported AGE Chronic idiopathic hyponatremia in older people due to syndrome of inappropriate antidiuretic hormone secretion (SIADH) possibly related to aging.

18. REFERENCES REFERENCES. Ho VB, Fitz CR, Yoder CC, Geyer CA. Resolving MR features inosmotic myelinolysis (central pontine and extrapontine myelinolysis). http://www.sma.org.sg/smj/4101/references/4101me1ref.htm

REFERENCES Ho VB, Fitz CR, Yoder CC, Geyer CA. Resolving MR features in osmotic myelinolysis (central pontine and extrapontine myelinolysis). AJNR 1993; 14:163-7. Martin PJ, Young CA. Central pontine myelinolysis: clinical and MRI correlates. Postgrad Med J 1995; 71:430-42. Laaureno R, Karp BI. Myelinolysis after correction of hyponatremia. Ann Intern Med 1997; 126:57-62. McGraw P, Edwards-Brown MK. Reversal of MR findings of central pontine myelinolysis. J Comput Assist Tomogr 1998; 22:989-91. Gregorio L, Sutton CL, Lee DA. Central pontine myelinolysis in a previously healthy 4-year-old child with acute rotavirus gastroenteritis. Pediatrics 1997; 99:738-43. Karp BI, Laureno R. Pontine and extrapontine myelinolysis: a neurologic disorder following rapid correction of hyponatremia. Medicine (Baltimore) 1993; 72:359-73. Korogi Y, Takahashi M, Shinzato J, Sakamoto Y, Mitsuzaki K, Hirai T, et al. MR findings in two presumed cases of mild central pontine myelinolysis. AJNR 1993; 14:651-4. Gocht A, Colmant HJ. Central pontine and extrapontine myelinolysis: a report of 58 cases. Clin Neuropathol 1987; 6:262-70.

19. Singapore Medical Journal The latter condition is termed extrapontine myelinolysis (EPM)(1). In both CPM andEPM, bilateral and symmetrical involvement is usually the rule (Figs 2a b http://www.sma.org.sg/smj/4101/articles/4101me1ans.htm

Journals Present Issue Past Issues THESMANEWS Present Issue Past Issues SMJ Editorial Board Letters to the Editor Instructions to Authors S I N G A P O R E M E D I C A L J O U R N A L This site is supported by Health ONE Singapore Med J 2000; Vol 41(1): Clinics in Diagnostic Imaging (45) C Y Chan, H S Lam, J R Jinkins IMAGE INTERPRETATION MR scans showede a 1 cm area of T2 hyperintensity in the central pontine region (Fig 1a) . In a patient with a history of sodium replacement, this finding is in keeping with osmotic myelinolysis (or central pontine myelinolysis). Multiple areas of T2 hyperintensity were seen in the basal ganglia and deep white matter (Fig 1b) , representing part of the same process. DIAGNOSIS Osmotic myelinolysis (central pontine myelinolysis) CLINICAL COURSE The patient did not improve clinically over the following months. She developed spastic tetraparesis, pseudobulbar palsy and horizontal nystagmus. Because of mutism, antidepressants were tried but they were not effective. She remained bed-ridden and ventilator-dependent. During her hospital stay, she developed several episodes of chest and urinary tract infection which were controlled with antibiotics. The patient finally died one year later due to multiple organ failure and sepsis. DISCUSSION Osmotic myelinolysis (OM) is a demyelinating disease that can develop following rapid correction of hyponatremia from any cause. It was originally described in chronic alcoholics. Other reported associations include malnourished status, renal failure, diabetes mellitus, and post-orthotopic liver transplantation

20. CMJ_netprints Pontine and extrapontine myelinolysis caused by hyponatremia Reportof two cases. LUO Benyan?,ZHANG Minming?, RUAN http://www.cmj.org/netprints/02/06/020611.htm

Pontine and extrapontine myelinolysis caused by hyponatremia: Report of two cases LUO BenyanÂÞ±¾Ñ࣬ZHANG MinmingÕÅôù, RUAN LingxiangÈîÁèÏè, JIN Haiqing½ðº£Çå, WANG QidongÍôÆô¶«, ZHANG Kan ÕÅÙ© Deparments of Neurology (Luo BY, Jin QH and Zhang K) and Radiology (ZhangMM, Ruan LX and Wang QD). First Hospital Zhejiang Uniersity.HangZhou 310009,China Key words£º hyponatremia £¬ myelinolysis Abstract: The central pontine myelinolysis was first described by Adams et al in 1959 .It is usually associated with hyponatremia or rapid correction of this condition. It is an uncommon complication in sick patients with severe underlying disorders such as chronic alcoholism, malignancy, malnutrition, hyponatraemia, hyperhydrated postoperatively, and in other clinical situations .We report two cases of myelinolysis caused by hyponatremia and cyclosporine. They are characterized by mental status changes, one of which had quadriplegia and pseudobulbar palsy. Brain MRI shows hyperintense on T2-weighted images and hypointense on T1-weighted images on the pontine and extrapontine. Myelinolysis is a neurological disorder that may occur after rapid correction of hyponatremia. It is an uncommon complication in sick patients with severe underlying disorders such as chronic alcoholism, malignancy, malnutrition, hyponatremia, and hyperhydrated postoperatively, and in other clinical situations. It is characterized by quadriplegia and pseudobulbar palsy, which sometimes evolves into a locked-in syndrome. [1, 2,] The exact pathogenesis of myelinolysis has not been determined. We report two patients caused by hyponatremia and cyclosporine who developed myelinolysis.

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