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Central pontine myelinolysis
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==Signs and symptoms== [[File:Extrapontine myelinolysis T2 01.jpg|thumb|T2 weighted magnetic resonance scan image showing bilaterally symmetrical hyperintensities in [[caudate nucleus]] (small, thin arrow), [[putamen]] (long arrow), with sparing of [[globus pallidus]] (broad arrow), suggestive of extrapontine myelinolysis (osmotic demyelination syndrome)]] Symptoms depend on the regions of the brain involved. Prior to its onset, patients may present with the neurological signs and symptoms of hyponatraemic encephalopathy such as nausea and vomiting, confusion, headache and seizures. These symptoms may resolve with normalisation of the serum sodium concentration. Three to five days later, a second phase of neurological manifestations occurs correlating with the onset of myelinolysis. Observable immediate precursors may include seizures, disturbed consciousness, gait changes, and decrease or cessation of respiratory function.<ref name="pmid16218318">{{cite journal | vauthors = Musana AK, Yale SH | title = Central pontine myelinolysis: case series and review | journal = WMJ | volume = 104 | issue = 6 | pages = 56β60 | date = August 2005 | pmid = 16218318 }}<!--|access-date=2014-05-29--></ref><ref>{{cite journal | vauthors = Odier C, Nguyen DK, Panisset M | title = Central pontine and extrapontine myelinolysis: from epileptic and other manifestations to cognitive prognosis | journal = Journal of Neurology | volume = 257 | issue = 7 | pages = 1176β1180 | date = July 2010 | pmid = 20148334 | doi = 10.1007/s00415-010-5486-7 | s2cid = 25301314 }}</ref> The classical clinical presentation is the progressive development of spastic [[quadriparesis]], [[pseudobulbar palsy]], and emotional lability ([[pseudobulbar affect]]), with other more variable neurological features associated with brainstem damage. These result from a rapid myelinolysis of the [[corticobulbar]] and [[corticospinal]] tracts in the brainstem.<ref name="pmid8231786">{{cite journal | vauthors = Karp BI, Laureno R | title = Pontine and extrapontine myelinolysis: a neurologic disorder following rapid correction of hyponatremia | journal = Medicine | volume = 72 | issue = 6 | pages = 359β373 | date = November 1993 | pmid = 8231786 | doi = 10.1097/00005792-199311000-00001 | s2cid = 24829955 | doi-access = free }}<!--|access-date=2014-05-29--></ref> In about ten per cent of people with central pontine myelinolysis, extrapontine myelinolysis is also found. In these cases symptoms of [[Parkinson's disease]] may be generated.<ref name="Yoon"/>
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