Pontine and Extrapontine Myelinolysis

Wright, Brad; Laureno, Robert; Victor, Maurice

doi:10.1093/brain/102.2.361

Cited by 311 publications

(132 citation statements)

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“…5 Within the zone of demyelination, blood vessels, neurons, and axis cylinders are largely spared, and in¯ammation is absent. 6 In previous reports, the onset of CPM and EPM was linked to a rapid correction of serum sodium to normal, or a change in serum sodium greater than 25 mmol/l within 48 h or hypoxia/anoxia. More recent reports have pointed toward hyperosmolality and rapid osmotic shifts, with resultant hypernatremia, hyperglycemia, and azotemia, rather than to absolute serum sodium level alone as causes of CPM and EPM.…”

Section: Discussionmentioning

confidence: 95%

Extra pontine myelinolysis in a tetraplegic patient: Case report

Moore¹,

Midha²

1997

Spinal Cord

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Hyposmolar hyponatremia (serum sodium5130 mmol/l) is a common phenomenon in the spinal cord injury (SCI) patient population and in most cases, it is of relatively little consequence. However, rapid correction or over correction of hyponatremia (a change in serum sodium425 mmol/l within 48 h) has been linked to Central Pontine Myelinolysis (CPM) and Extra Pontine Myelinolysis (EPM), usually along with other recognized predisposing factors. We report the ®rst case of isolated Extra Pontine Myelinolysis in an SCI patient without any of the recognized predisposing factors, following correction of hyponatremia. The signs and symptoms of Extra Pontine Myelinolysis were not very remarkable in our patient because of prior spinal cord injury. The diagnosis was con®rmed by the typical ®nding of myelinolysis in the basal ganglion region on MRI. Hyponatremia occurs frequently in the SCI patient population, thus placing them at increased risk for Extra Pontine Myelinolysis. Therefore, we emphasize the importance of watching for this entity during the management of hyponatremia in the SCI patient population and recommend the use of MRI scans to con®rm the clinical diagnosis.

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Section: Discussionmentioning

confidence: 95%

Extra pontine myelinolysis in a tetraplegic patient: Case report

Moore¹,

Midha²

1997

Spinal Cord

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“…Hyponatremia and its rapid correction are thought to be a commontrigger to this non-inflammatory demyelination, and it progresses rapidly and in general improves incompletely. EPM, found in 10%of CPM, is characterized by symmetrical demyelinating foci in the thalamus, subthalamic nucleus, striatum, internal capsule, amygdaloid body, lateral geniculate body, cerebellar white matter and deep layers of the cortex (2). Recently, with the advent of refined imaging diagnosis, numerousreports have described a mild form and an incomplete form (5, 6).…”

Section: Discussionmentioning

confidence: 99%

“…It was considered to be a disorder that progresses rapidly and often terminates in death (1). In addition to CPM,Wright et al accumulated autopsied cases with similar myelinolytic lesions in those structures outside the pons, and the term, extrapontine myelinolysis (EPM) was coined (2). With the advent of refined imaging techniques, mild and incomplete forms have been identified, and it became clear that the disorder is not necessarily incompatible with life but improves in time.…”

Section: Introductionmentioning

confidence: 99%

Slowly Progressive Dystonia Following Central Pontine and Extrapontine Myelinolysis.

et al. 2000

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A 28-year-old womanwas hospitalized with dysarthria and oro-mandibular and upper limb dystonia. Approximately 8 years prior to the current admission, the woman became severely hyponatremic due to traumatic subarachnoid hemorrhage-related SIADH.Brain MRIsshowed a signal increase in the central pons, thalamus and striatum on T2 weighted images compatible with central pontine and extrapontine myelinolysis. Froma few monthsafter that event, dystonia progressed slowly over the subsequent 8 years. Wespeculate that the particular damage chiefly to the myelin structures by myelinolytic process mayhave caused an extremely slow plastic reorganization of the neural structures, giving rise to progressive dystonia. (Internal Medicine 39: 956-960, 2000)

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“…Patients with osmotic myelinolysis may present with confusion, quadriplegia, pseudobulbar palsy or locked-in syndrome [93]. Osmotic myelinolysis classically occurs in the setting of rapidly corrected severe hyponatremia of several days duration [94].…”

Section: Osmotic Myelinolysismentioning

confidence: 99%

“Dazed and diffused”: making sense of diffusion abnormalities in neurologic pathologies

O’Connor

Barest²,

Moritani³

et al. 2013

BJR

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To review diffusion abnormalities seen in diffusion-weighted MRI in neurological pathologies. We examine the clinical significance of the abnormalities in a broad spectrum of neurological diseases and highlight our current understanding of their causes. Diffusion abnormalities seen on diffusion-weighted MRI can play an important role in the diagnosis and follow-up of a broad spectrum of neurological diseases. A thorough understanding of the appearance and significance of these abnormalities is critical in patient management.Although the best known use of diffusion-weighted imaging (DWI) in MRI of the brain is detection of acute vaso-occlusive infarct, diffusion abnormalities occur in a wide spectrum of neurological pathologies. These diffusion abnormalities provide information that can directly affect the management of a patient, whether identifying pathology that would otherwise go unrecognised, narrowing a broad differential diagnosis, identifying conditions that require emergent intervention, evaluating response to treatment or providing prognostic information about a patient's expected clinical course. In this review, we explain the significance of diffusion abnormalities in a variety of neurological diseases and highlight our current understanding of the causes of these diffusion abnormalities.

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Pontine and Extrapontine Myelinolysis

Cited by 311 publications

References 0 publications

Extra pontine myelinolysis in a tetraplegic patient: Case report

Extra pontine myelinolysis in a tetraplegic patient: Case report

Slowly Progressive Dystonia Following Central Pontine and Extrapontine Myelinolysis.

“Dazed and diffused”: making sense of diffusion abnormalities in neurologic pathologies

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