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  1. Methylphenidate Treatment of Neuropsychiatric Symptoms of Central and Extrapontine Myelinolysis(*).: An article from: Journal of Studies on Alcohol by Denise Bridgeford, David B. Arciniegas, et all 2000-09-01

1. Ae
extrapontine myelinolysis. Findings Axial CT images with and without contrast demonstrate patchy areas of symmetric
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. Myelinolysis After Correction Of..., Annals 1 Jan 97
appropriate than "central pontine myelinolysis" for demyelination occurring in extrapontine regions after the correction
Annals of Internal Medicine Current Issue Past Issues Library for Internists Subscriptions ... Email this page Annals of Internal Medicine UPDATES
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. Experiments have duplicated the clinical and pathologic features of myelinolysis by rapidly reversing hyponat remia in animals. Myelinolysis is more likely to occur after the treatment of chronic rather than acute hyponatremia and is more likely to occur with a rapid rate of correction. The exact pathogenesis of myelinolysis has not been determined. Optimal management of hyponatremic patients involves weighing the risk for illness and death from untreated hyponatremia against the risk for myelinolysis due to correction of hyponatremia. Experiments in animals and clinical experience suggest that correction of chronic hyponatremia should be kept at a rate less than 10 mmol/L in any 24-hour period.

3. Hyponatremia And Myelinolysis, Annals 15 Jul 97
Hyponatremia and Myelinolysis. Annals of Internal Medicine 15 Jul 97. 1. Karp BP, Laureno R. Pontine and extrapontine myelinolysis. A neurological disorder following rapid correction of
Annals of Internal Medicine Current Issue Past Issues Library for Internists Subscriptions ... Email this page Annals of Internal Medicine LETTERS
Hyponatremia and Myelinolysis
Annals of Internal Medicine 15 July 1997.
Related Article
To the Editor: Annals in which their review appears. In summary, brain damage from hyponatremic encephalopathy due to delayed onset of therapy is at least 24 times more likely than brain damage due to improper therapy. Most patients who have brain damage secondary to hyponatremic encephalopathy are young (menstruant) women (4), whereas those who have brain damage from a change in plasma sodium concentration usually have end-stage liver disease. J. Carlos Ayus, MD
Baylor College of Medicine
Houston, TX 77024 Allen I. Arieff, MD
University of California Medical Center
San Francisco, CA 94143
Laureno R, Karp BI. Myelinolysis after correction of hyponatremia. Ann Intern Med. 1997;126:57-62.
2. Sarnaik AP, Meert K, Hackbarth R, Fleischmann L.

4. Untitled
(2) medulla oblongata midbrain pontine tegmentum extrapontine myelinolysis. Symptoms with pontine involvement
Myelinolysis Table of Contents, Chap. 17 Developing Myelinolysis Overview: Myelinolysis is more likely to occur if certain risk factors are present. Awareness of the risk factors can help prevent occurrence of this serious neurologic disorder. Risk factors: (3) presence of chronic liver disease in a patient with hyponatremia (4) history of orthotopic liver transplantation in a patient with hyponatremia where: • I am not sure if the risk for patients following orthotopic liver transplants is independent of the hyponatremia. References: Adrogue HJ Madias NE. Hyponatremia. N Engl J Med. 2000; 342: 1581-1589. Laureno R Karp BI. Myelinolysis after correction of hyponatremia. Ann Intern Med. 1997; 126: 57-62. Table of Contents, Chap. 17 Myelinolysis Overview: Myelinolysis is a cerebral disorder that features myelin degeneration following correction of hyponatremia. It is distinct from demyelination and may affect neuronal elements to a lesser degree. Most cases affect the pons but other areas of the brain may be affected. Prevention and early recognition can help reduce development of serious complications. Features: (1) history of hyponatremia often with rapid sodium replacement (2) clinical findings compatible with the site of involvement (3) onset several days after correction of the hyponatremia (4) MRI shows an increased signal in the area of involvement usually symmetrical (CT scans are often negative) Sites of involvement: (1) pons: central pontine myelinolysis (2) medulla oblongata midbrain pontine tegmentum: extrapontine myelinolysis

5. Central And Extrapontine Myelinolysis Following Allogeneic Peripheral Haematopoi
Case Report. Central and extrapontine myelinolysis following allogeneicperipheral haematopoietic progenitor cell transplantation.

6. BMT Table Of Contents, Volume 31, Number 1
Central and extrapontine myelinolysis following allogeneic peripheralhaematopoietic progenitor cell transplantation. Favourable about npg nature science update naturejobs ... help SEARCH my account e-alerts subscribe register ... Journal home For readers Content Online sample issue E-alerts Indexed in ... Society publishing NPG Subject areas Access material from all our publications in your subject area: Biotechnology Cancer Chemistry Clinical Medicine ... Physics
January (1) 2003, Volume 31, Number 1 Table of Contents Previous Mini Review Mucosal injury in patients undergoing hematopoietic progenitor cell transplantation: new approaches to prophylaxis and treatment Abstract Full text PDF Non-myeloablative Stem Cell Transplants Fludarabine in combination with cyclophosphamide decreases incidence of GVHD and maintains effective graft-versus-leukemia effect after allogeneic stem cell transplantation in murine lymphocytic leukemia Abstract Full text PDF Progenitor Cell Mobilisation Large-scale isolation of CD133+ progenitor cells from G-CSF mobilized peripheral blood stem cells Abstract Full text PDF Peripheral Blood Stem Cells Patients with acute lymphoblastic leukaemia allografted with a matched unrelated donor may have a lower survival with a peripheral blood stem cell graft compared to bone marrow Abstract Full text PDF Immune Reconstitution Cytotoxic chemotherapy preceding apheresis of peripheral blood progenitor cells can affect the early reconstitution phase of naive T cells after autologous transplantation Abstract Full text PDF Donor Lymphocyte Infusions Donor lymphocyte infusions in adult haploidentical transplant: a dose finding study Abstract Full text PDF Gonadal Function Post-transplant

7. MR Imaging Of Seven Presumed Cases Of Central Pontine And
cases of central pontine and. extrapontine myelinolysis. Monika BekiesiñskaFigatowska

8. Neurology India Volume 48 Issue 1
NEUROIMAGE VOL481, Pontine and extrapontine myelinolysis Following Rapid Correctionof Hyponatremia, T. Srivastava, P. Singh, B. Sharma. BOOK REVIEW VOL48-1,
Neurology India Volume 48 Issue 1 2000 INDEX - VOLUME 48 - ISSUE 1 ORATION VOL48-1 Stereotactic Surgery in India : The Past, Present and the Future B. Ramamurthi
Dr. A.L. Neurosurgical Centre, V.H.S. Hospital, Madras-600118, India. REVIEW ARTICLE VOL48-1 Anterior Surgical Approaches to the Sub-axial Cervical Spine V. K. Khosla, S. K. Gupta, B. S. Sharma, S. N. Mathuriya
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India. ORIGINAL ARTICLE VOL48-1 Centronuclear Myopathy - Morphological Relation to Developing Human Skeletal Muscle : A Clinicopathological Evaluation N. Gayathri, S. Das, A. Vasanth, M. Gourie Devi, Y. Ramamohan, V. Santosh, T. C. Yasha, S. K. Shankar
Departments of Neuropathology and Neurology, National Institute of Mental Health and Neurosciences, Bangalore-560029, India. Usefulness of Short Term Video-EEG Monitoring in Children with Frequent Intractable Episodes G. Srikumar, M. Bhatia, S. Jain , M. C. Maheshwari
Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi- 110029, India.

9. Files2
laryngocele dural fibrosis after shunt placement -Wernicke's syndrome -Adrenoleukodystrophy-Leigh Disease -extrapontine myelinolysis -langerhans cell
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
herpes encephalitis



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.

10. P Ontine And Extrapontine My Elinol Ysis Follo Wing Rapid Correction Neurology I
Central pontine and extrapontine myelinolysis (CPM EPM) is neurological complication after correction of hyponatremia.

11. Volume 102 January - December 1979
Pontine and extrapontine myelinolysis. DG . Wright , R . Laureno and M . Victor.Pages 361 386. Part of the OUP Brain WWW service. General Information.
Volume 102: January - December 1979
Issue 2: June 1979
  • Pontine and extrapontine myelinolysis
  • DG Wright R Laureno and M Victor Pages: Part of the OUP Brain WWW service
    General Information
    Click here to register with OUP. This page is maintained by OUP admin Last updated 14 May 97 Part of the OUP Journals World Wide Web service Oxford University Press, 1997

    12. Abstract
    of 35 paediatric cases of pontine and/or extrapontine myelinolysis are reported and, to our knowledge, CPM secondary to
    Case Report
    Central pontine myelinolysis secondary to cytomegalovirus hepatitis in a 10-month-old child
    N. Cagla Tarhan , Ali Firat , Arzu Otken , A. Muhtesem Agildere and Fulya Demirceken Fevzi Cakmak Cad. 10. Sok. No:45, 06490 Bahcelievler, Ankara, Turkey Sami Ulus Children's Hospital, Department of Paediatrics, Ankara, Turkey Abstract. We present a 10-month-old child with central pontine myelinolysis (CPM) secondary to chronic active hepatitis due to cytomegalovirus (CMV) infection. A total of 35 paediatric cases of pontine and/or extrapontine myelinolysis are reported and, to our knowledge, CPM secondary to CMV hepatitis in an infant has not been previously reported. The MRI findings are highlighted. Keywords. Central pontine myelinolysis - CMV - MRI - Infant E-mail:
    Phone: +90-312-2126868
    Fax: +90-312-223-7333

    REFERENCES Ho VB, Fitz CR, Yoder CC, Geyer CA. Resolving MR features inosmotic myelinolysis (central pontine and extrapontine myelinolysis).
  • 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.
  • 14. 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
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    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

    15. OA
    Pontine and extrapontine myelinolysis caused by hyponatremia Report of two casesLUO Benyan?,ZHANG Minming?, RUAN Lingxiang?, JIN
    Pontine and extrapontine myelinolysis caused by hyponatremia: Report of two cases LUO Benyan ZHANG Minming , RUAN Lingxiang , JIN Haiqing , WANG Qidong , ZHANG Kan 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 hyponatremia myelinolysis Chin Med J 2002;115(6):987-988 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 hyperintens

    16. Ri_titles
    Pontine and extrapontine myelinolysis caused by hyponatremia Report of two cases(LUO Benyan?,ZHANG Minming?, RUAN Lingxiang?, JIN
    Vol.115 No. 12 DECEMBER 2002 Unsafe injection and HBV transmission in Guangxi, China Jiatong Zhuo MD, MSc, Adrian Sleigh MD, FRCP, MPH, Haitao Wang MD Involving the Chinese Consumers in Evidence-Based Medicine :A Baseling Survey of Current Status (ZHANG Mingming , WANG Li LI Jing HE Li The effect of insulin on nitric oxide synthase activity and the expression of inducible nitric oxide synthase mRNA in calf aortic endothelial cell s (ZHANG Hui , YE FuLin , LIU ZhiMin CT evaluation of lymphoma in the abdominal lymph nodes (YU RishengÓàÈÕʤ ,LIU YiqingÁõÞÈÇà ,ZHANG ShizhengÕÂÊ¿Õý ,WU JinxiuÎâèªÐã and LI RongfenÀîÈØ·Ò.) Progression of the onset of type 1 diabetes and cells apoptosis in female NOD mice with spontaneous diabetes (YUAN Tao, WANG Heng, SUN Qi The Immunologic Pathogenesis of Natural Killer(NK)Cells in Multiple Sclerosis(MS) (YAN xiao-bo, HAN wei, WANG-weizhi

    17. Myelinolysis
    documed Demyelinating diseases Myelinolysis Clinical features Parkinsonismand dystonia in central pontine and extrapontine myelinolysis J Neurol Neurosurg
    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
  • 18. EMedicine - Central Pontine Myelinolysis : Article By Christopher C Luzzio, MD
    Central Pontine Myelinolysis An introduction, clinical features, differencials, work up, treatment Category Health Conditions and Diseases...... Karp BI, Laureno R Pontine and extrapontine myelinolysis a neurologicdisorder following rapid correction of hyponatremia. Medicine
    document.write(''); (advertisement) Home Specialties CME PDA ... Patient Education Articles Images CME Patient Education Advanced Search 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 Medical Center; 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

    19. SpringerLink: Journal Of Neural Transmission - Abstract Volume 106 Issue 9/10 (1
    extrapontine myelinolysis with parkinsonism after rapid correction of hyponatremiahigh cerebrospinal fluid level of homovanillic acid and successful
    Journal of Neural Transmission
    ISSN: 0300-9564 (printed version)
    ISSN: 1435-1463 (electronic version) Table of Contents Abstract Volume 106 Issue 9/10 (1999) pp 949-953
    Extrapontine myelinolysis with parkinsonism after rapid correction of hyponatremia: high cerebrospinal fluid level of homovanillic acid and successful dopaminergic treatment
    S. Nagamitsu (1), T. Matsuishi (1), Y. Yamashita (1), S. Yamada (2), H. Kato (1)
    (1) Department of Pediatrics and Child Health, and
    (2) Institute of Brain Disease, Kurume University School of Medicine, Kurume, Japan
    Received December 2, 1998; accepted May 6, 1999 Summary. Extrapontine myelinolysis (EPM) is a demyelinating process of the brain. We report the case of an 11-year-old girl who developed EPM with parkinsonism. Magnetic resonance imaging revealed demyelinating patterns in the basal ganglia without central pontine lesions. The cerebrospinal fluid levels of homovanillic acid and 5-hydroxyindoleacetic acid were high at the time of onset and normalized upon complete recovery from extrapyramidal symptoms after a dopaminergic treatment. We speculated that demyelination of nerve fibers containing dopamine receptors in the striatum might be a main cause of these symptoms.

    20. Contents Of Current Volume AN
    BULSKI T., RÓZYCZKA I., FURMANEK M. and WALECKI J. MR imaging of seven presumedcases of central pontine and extrapontine myelinolysis 141 Abstract / Article
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