https://www.wikidoc.org/index.php?title=Central_pontine_myelinolysis_pathophysiology&feed=atom&action=history
Central pontine myelinolysis pathophysiology - Revision history
2024-03-29T14:09:43Z
Revision history for this page on the wiki
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Syed Musadiq Ali at 20:33, 7 July 2020
2020-07-07T20:33:12Z
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Syed Musadiq Ali
https://www.wikidoc.org/index.php?title=Central_pontine_myelinolysis_pathophysiology&diff=1607216&oldid=prev
M Jahan at 05:02, 6 May 2020
2020-05-06T05:02:45Z
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<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>{{Central pontine myelinolysis}}</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>{{Central pontine myelinolysis}}</div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>{{CMG}}; {{AE}} {{MMJ}}</div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>{{CMG}}; {{AE}} <ins style="font-weight: bold; text-decoration: none;">{{sali}}, </ins>{{MMJ}}</div></td></tr>
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<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Overview==</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Overview==</div></td></tr>
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M Jahan
https://www.wikidoc.org/index.php?title=Central_pontine_myelinolysis_pathophysiology&diff=1603285&oldid=prev
M Jahan at 18:30, 3 April 2020
2020-04-03T18:30:49Z
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 18:30, 3 April 2020</td>
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<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Overview==</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Overview==</div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>It is understood that central pontine myelinolysis is caused by the rapid correction of [[hyponatremia]]. The [[CNS]] is particularly susceptible to reductions in [[plasma osmolarity]], specially during [[hyponatremia]] which is the most commonly encountered [[electrolyte disturbance]]. When a decrease in the plasma [[osmolarity]] happens, neural cells first swell but then they are able to regain their original volume through the release of inorganic and organic osmolytes and exit of osmotically obligated water. Subsequent exposure to hypertonic stress(e.g., correction of [[hyponatremia]] with hypertonic I.V. solutions)resulting from a rapid correction of [[hyponatremia]] causes the [[ions]] to quickly re-enter the intracellular space and compels the water to follow. If the serum sodium levels rise too rapidly, the increased extracellular tonicity will continue to drive water out of the brain's cells because the brain cells do not have enough time to bring extracellular sodium into the cell, so the water goes out very fast. This can lead to cellular dysfunction and central pontine myelinolysis and finally death.</div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>It is understood that central pontine myelinolysis is caused by the rapid correction of [[hyponatremia]]. The [[CNS]] is particularly susceptible to reductions in [[plasma osmolarity]], specially during [[hyponatremia]] which is the most commonly encountered [[electrolyte disturbance]]. When a decrease in the plasma [[osmolarity]] happens, neural cells first swell but then they are able to regain their original volume through the release of inorganic and organic osmolytes and exit of osmotically obligated water. Subsequent exposure to hypertonic stress(e.g., correction of [[hyponatremia]] with hypertonic I.V. solutions)resulting from a rapid correction of [[hyponatremia]] causes the [[ions]] to quickly re-enter the intracellular space and compels the water to follow. If the serum <ins style="font-weight: bold; text-decoration: none;">[[</ins>sodium<ins style="font-weight: bold; text-decoration: none;">]] </ins>levels rise too rapidly, the increased extracellular tonicity will continue to drive water out of the brain's cells because the brain cells do not have enough time to bring extracellular sodium into the cell, so the water goes out very fast. This can lead to cellular dysfunction and central pontine myelinolysis and finally death.</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Pathophysiology==</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Pathophysiology==</div></td></tr>
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<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Infiltration by [[Lymphocyte|lymphocytes]] is sparse or absent.</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Infiltration by [[Lymphocyte|lymphocytes]] is sparse or absent.</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Axons and neurons are mostly well preserved.</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Axons and neurons are mostly well preserved.</div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>*Symmetrically spared “islands” of [[myelinated]] white matter</div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>*Symmetrically spared “islands” of [[myelinated]] <ins style="font-weight: bold; text-decoration: none;">[[</ins>white matter<ins style="font-weight: bold; text-decoration: none;">]]</ins></div></td></tr>
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M Jahan
https://www.wikidoc.org/index.php?title=Central_pontine_myelinolysis_pathophysiology&diff=1603270&oldid=prev
M Jahan at 17:30, 3 April 2020
2020-04-03T17:30:23Z
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 17:30, 3 April 2020</td>
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<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>===Pathogenesis===</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>===Pathogenesis===</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>*It is understood that central pontine myelinolysis is caused by rapid correction of [[hyponatremia]].<ref name="pmid24682140">{{cite journal| author=Mascarenhas JV, Jude EB| title=Central pontine myelinolysis: electrolytes and beyond. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue= | pages= | pmid=24682140 | doi=10.1136/bcr-2013-203516 | pmc=3975522 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24682140 }} </ref></div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>*It is understood that central pontine myelinolysis is caused by rapid correction of [[hyponatremia]].<ref name="pmid24682140">{{cite journal| author=Mascarenhas JV, Jude EB| title=Central pontine myelinolysis: electrolytes and beyond. | journal=BMJ Case Rep | year= 2014 | volume= 2014 | issue= | pages= | pmid=24682140 | doi=10.1136/bcr-2013-203516 | pmc=3975522 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24682140 }} </ref<ins style="font-weight: bold; text-decoration: none;">><ref name="pmid23760391" /</ins>></div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*The [[CNS]] is particularly susceptible to reductions in [[plasma osmolarity]], specially during [[hyponatremia]] which is the most commonly encountered [[electrolyte disturbance]].</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*The [[CNS]] is particularly susceptible to reductions in [[plasma osmolarity]], specially during [[hyponatremia]] which is the most commonly encountered [[electrolyte disturbance]].</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*When a decrease in the plasma [[osmolarity]] happens, neural cells first swell but then they are able to regain their original volume through the:<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref><ref name="pmid18256030">Burg MB, Ferraris JD (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18256030 Intracellular organic osmolytes: function and regulation.] ''J Biol Chem'' 283 (12):7309-13. [http://dx.doi.org/10.1074/jbc.R700042200 DOI:10.1074/jbc.R700042200] PMID: [https://pubmed.gov/18256030 18256030]</ref></div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*When a decrease in the plasma [[osmolarity]] happens, neural cells first swell but then they are able to regain their original volume through the:<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref><ref name="pmid18256030">Burg MB, Ferraris JD (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18256030 Intracellular organic osmolytes: function and regulation.] ''J Biol Chem'' 283 (12):7309-13. [http://dx.doi.org/10.1074/jbc.R700042200 DOI:10.1074/jbc.R700042200] PMID: [https://pubmed.gov/18256030 18256030]</ref></div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*#Release of inorganic and organic osmolytes</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*#Release of inorganic and organic osmolytes</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*#Exit of osmotically obligated water</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*#Exit of osmotically obligated water</div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>*A subsequent exposure to hypertonic stress(e.g., correction of [[hyponatremia]] with hypertonic I.V. solution's)resulting from a rapid correction of [[hyponatremia]] causes the [[ions]] to quickly re-enter the intracellular space and compels the water to follow.<ref name="pmid30357070">{{cite journal| author=Sheikh AB, Afzal RM, Sagheer S, Bukhari MM, Javed A, Nasrullah A et al. z| title=The Dilemma of Inadvertent Pontine Demyelinosis: A Review of Literature. | journal=Cureus | year= 2018 | volume= 10 | issue= 8 | pages= e3174 | pmid=30357070 | doi=10.7759/cureus.3174 | pmc=6197531 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30357070 }} </ref></div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>*A subsequent exposure to hypertonic stress(e.g., correction of [[hyponatremia]] with hypertonic I.V. solution's)resulting from a rapid correction of [[hyponatremia]] causes the [[ions]] to quickly re-enter the intracellular space and compels the water to follow.<ref name="pmid30357070">{{cite journal| author=Sheikh AB, Afzal RM, Sagheer S, Bukhari MM, Javed A, Nasrullah A et al. z| title=The Dilemma of Inadvertent Pontine Demyelinosis: A Review of Literature. | journal=Cureus | year= 2018 | volume= 10 | issue= 8 | pages= e3174 | pmid=30357070 | doi=10.7759/cureus.3174 | pmc=6197531 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30357070 }} </ref<ins style="font-weight: bold; text-decoration: none;">><ref name="pmid23760391" /><ref name="pmid24682140" /</ins>></div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>*If the serum sodium levels rise too rapidly, the increased [[Extracellular|extracellular tonicity]] will continue to drive water out of the brain neurons because the brain cells do not have enough time to bring [[Extracellular|extracellular sudiom]] into the cell, so the water goes out very fast instead.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref></div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>*If the serum sodium levels rise too rapidly, the increased [[Extracellular|extracellular tonicity]] will continue to drive water out of the brain neurons because the brain cells do not have enough time to bring [[Extracellular|extracellular sudiom]] into the cell, so the water goes out very fast instead.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref<ins style="font-weight: bold; text-decoration: none;">><ref name="pmid24682140" /</ins>></div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>*This can lead to cellular dysfunction and central pontine myelinolysis and finally death.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref></div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>*This can lead to cellular dysfunction and central pontine myelinolysis and finally death.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref<ins style="font-weight: bold; text-decoration: none;">><ref name="pmid24682140" /</ins>></div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Genetics==</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Genetics==</div></td></tr>
</table>
M Jahan
https://www.wikidoc.org/index.php?title=Central_pontine_myelinolysis_pathophysiology&diff=1601371&oldid=prev
M Jahan at 07:26, 5 March 2020
2020-03-05T07:26:34Z
<p></p>
<table style="background-color: #fff; color: #202122;" data-mw="interface">
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">← Older revision</td>
<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 07:26, 5 March 2020</td>
</tr><tr><td colspan="2" class="diff-lineno" id="mw-diff-left-l14">Line 14:</td>
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<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*#Release of inorganic and organic osmolytes</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*#Release of inorganic and organic osmolytes</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*#Exit of osmotically obligated water</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*#Exit of osmotically obligated water</div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>*A subsequent exposure to hypertonic stress(e.g., correction of [[hyponatremia]] with hypertonic I.V. solution's)resulting from a rapid correction of [[hyponatremia]] causes the [[ions]] to quickly re-enter the <del style="font-weight: bold; text-decoration: none;">[[</del>intracellular space<del style="font-weight: bold; text-decoration: none;">]] </del>and compels the water to follow.<ref name="pmid30357070">{{cite journal| author=Sheikh AB, Afzal RM, Sagheer S, Bukhari MM, Javed A, Nasrullah A et al. z| title=The Dilemma of Inadvertent Pontine Demyelinosis: A Review of Literature. | journal=Cureus | year= 2018 | volume= 10 | issue= 8 | pages= e3174 | pmid=30357070 | doi=10.7759/cureus.3174 | pmc=6197531 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30357070 }} </ref></div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>*A subsequent exposure to hypertonic stress(e.g., correction of [[hyponatremia]] with hypertonic I.V. solution's)resulting from a rapid correction of [[hyponatremia]] causes the [[ions]] to quickly re-enter the intracellular space and compels the water to follow.<ref name="pmid30357070">{{cite journal| author=Sheikh AB, Afzal RM, Sagheer S, Bukhari MM, Javed A, Nasrullah A et al. z| title=The Dilemma of Inadvertent Pontine Demyelinosis: A Review of Literature. | journal=Cureus | year= 2018 | volume= 10 | issue= 8 | pages= e3174 | pmid=30357070 | doi=10.7759/cureus.3174 | pmc=6197531 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30357070 }} </ref></div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*If the serum sodium levels rise too rapidly, the increased [[Extracellular|extracellular tonicity]] will continue to drive water out of the brain neurons because the brain cells do not have enough time to bring [[Extracellular|extracellular sudiom]] into the cell, so the water goes out very fast instead.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref></div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*If the serum sodium levels rise too rapidly, the increased [[Extracellular|extracellular tonicity]] will continue to drive water out of the brain neurons because the brain cells do not have enough time to bring [[Extracellular|extracellular sudiom]] into the cell, so the water goes out very fast instead.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref></div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*This can lead to cellular dysfunction and central pontine myelinolysis and finally death.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref></div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*This can lead to cellular dysfunction and central pontine myelinolysis and finally death.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref></div></td></tr>
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<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Infiltration by [[Lymphocyte|lymphocytes]] is sparse or absent.</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Infiltration by [[Lymphocyte|lymphocytes]] is sparse or absent.</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Axons and neurons are mostly well preserved.</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Axons and neurons are mostly well preserved.</div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>*Symmetrically spared “islands” of myelinated white matter</div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>*Symmetrically spared “islands” of <ins style="font-weight: bold; text-decoration: none;">[[</ins>myelinated<ins style="font-weight: bold; text-decoration: none;">]] </ins>white matter</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div><br /></div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div><br /></div></td></tr>
</table>
M Jahan
https://www.wikidoc.org/index.php?title=Central_pontine_myelinolysis_pathophysiology&diff=1592927&oldid=prev
M Jahan at 15:01, 24 December 2019
2019-12-24T15:01:38Z
<p></p>
<table style="background-color: #fff; color: #202122;" data-mw="interface">
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">← Older revision</td>
<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 15:01, 24 December 2019</td>
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<td colspan="2" class="diff-lineno">Line 4:</td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Overview==</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Overview==</div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>It is understood that central pontine myelinolysis is caused by the rapid correction of [[hyponatremia]]. The [[CNS]] is particularly susceptible to reductions in [[plasma osmolarity]], specially during [[hyponatremia]] which is the most commonly encountered [[electrolyte disturbance]]. When a decrease in the plasma [[osmolarity]] happens, neural cells first swell but then they are able to regain their original volume through the release of inorganic and organic osmolytes and exit of osmotically obligated water. Subsequent exposure to hypertonic stress(e.g., correction of [[hyponatremia]] with hypertonic I.V. solutions)resulting from a rapid correction of [[hyponatremia]] causes the [[ions]] to quickly re-enter the intracellular space and compels the water to follow. If the serum sodium levels rise too rapidly, the increased extracellular tonicity will continue to drive water out of the brain's cells because the brain cells do not have enough time to bring extracellular sodium into the cell, so the water <del style="font-weight: bold; text-decoration: none;">will go </del>out very fast. This can lead to cellular dysfunction and central pontine myelinolysis and finally death.</div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>It is understood that central pontine myelinolysis is caused by the rapid correction of [[hyponatremia]]. The [[CNS]] is particularly susceptible to reductions in [[plasma osmolarity]], specially during [[hyponatremia]] which is the most commonly encountered [[electrolyte disturbance]]. When a decrease in the plasma [[osmolarity]] happens, neural cells first swell but then they are able to regain their original volume through the release of inorganic and organic osmolytes and exit of osmotically obligated water. Subsequent exposure to hypertonic stress(e.g., correction of [[hyponatremia]] with hypertonic I.V. solutions)resulting from a rapid correction of [[hyponatremia]] causes the [[ions]] to quickly re-enter the intracellular space and compels the water to follow. If the serum sodium levels rise too rapidly, the increased extracellular tonicity will continue to drive water out of the brain's cells because the brain cells do not have enough time to bring extracellular sodium into the cell, so the water <ins style="font-weight: bold; text-decoration: none;">goes </ins>out very fast. This can lead to cellular dysfunction and central pontine myelinolysis and finally death.</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Pathophysiology==</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Pathophysiology==</div></td></tr>
<tr><td colspan="2" class="diff-lineno" id="mw-diff-left-l15">Line 15:</td>
<td colspan="2" class="diff-lineno">Line 15:</td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*#Exit of osmotically obligated water</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*#Exit of osmotically obligated water</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*A subsequent exposure to hypertonic stress(e.g., correction of [[hyponatremia]] with hypertonic I.V. solution's)resulting from a rapid correction of [[hyponatremia]] causes the [[ions]] to quickly re-enter the [[intracellular space]] and compels the water to follow.<ref name="pmid30357070">{{cite journal| author=Sheikh AB, Afzal RM, Sagheer S, Bukhari MM, Javed A, Nasrullah A et al. z| title=The Dilemma of Inadvertent Pontine Demyelinosis: A Review of Literature. | journal=Cureus | year= 2018 | volume= 10 | issue= 8 | pages= e3174 | pmid=30357070 | doi=10.7759/cureus.3174 | pmc=6197531 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30357070 }} </ref></div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*A subsequent exposure to hypertonic stress(e.g., correction of [[hyponatremia]] with hypertonic I.V. solution's)resulting from a rapid correction of [[hyponatremia]] causes the [[ions]] to quickly re-enter the [[intracellular space]] and compels the water to follow.<ref name="pmid30357070">{{cite journal| author=Sheikh AB, Afzal RM, Sagheer S, Bukhari MM, Javed A, Nasrullah A et al. z| title=The Dilemma of Inadvertent Pontine Demyelinosis: A Review of Literature. | journal=Cureus | year= 2018 | volume= 10 | issue= 8 | pages= e3174 | pmid=30357070 | doi=10.7759/cureus.3174 | pmc=6197531 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30357070 }} </ref></div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>*If the serum sodium levels rise too rapidly, the increased [[Extracellular|extracellular tonicity]] will continue to drive water out of the brain neurons because the brain cells do not have enough time to bring [[Extracellular|extracellular sudiom]] into the cell, so the water <del style="font-weight: bold; text-decoration: none;">will go </del>out very fast instead.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref></div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>*If the serum sodium levels rise too rapidly, the increased [[Extracellular|extracellular tonicity]] will continue to drive water out of the brain neurons because the brain cells do not have enough time to bring [[Extracellular|extracellular sudiom]] into the cell, so the water <ins style="font-weight: bold; text-decoration: none;">goes </ins>out very fast instead.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref></div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*This can lead to cellular dysfunction and central pontine myelinolysis and finally death.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref></div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*This can lead to cellular dysfunction and central pontine myelinolysis and finally death.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref></div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
</table>
M Jahan
https://www.wikidoc.org/index.php?title=Central_pontine_myelinolysis_pathophysiology&diff=1592926&oldid=prev
M Jahan: /* Pathophysiology */
2019-12-24T15:00:38Z
<p><span dir="auto"><span class="autocomment">Pathophysiology</span></span></p>
<table style="background-color: #fff; color: #202122;" data-mw="interface">
<col class="diff-marker" />
<col class="diff-content" />
<col class="diff-marker" />
<col class="diff-content" />
<tr class="diff-title" lang="en">
<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">← Older revision</td>
<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 15:00, 24 December 2019</td>
</tr><tr><td colspan="2" class="diff-lineno" id="mw-diff-left-l4">Line 4:</td>
<td colspan="2" class="diff-lineno">Line 4:</td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Overview==</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Overview==</div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>It is understood that central pontine myelinolysis is caused by the rapid correction of [[hyponatremia]]. The [[CNS]] is particularly susceptible to reductions in [[plasma osmolarity]], specially during [[hyponatremia]] which is the most commonly encountered [[electrolyte disturbance]]. When a decrease in the plasma [[osmolarity]] happens, neural cells first swell but then they are able to regain their original volume through the release of inorganic and organic osmolytes and exit of osmotically obligated water. Subsequent exposure to hypertonic stress(e.g., correction of [[hyponatremia]] with hypertonic I.V. solutions)resulting from a rapid correction of [[hyponatremia]] causes the [[ions]] to quickly re-enter the intracellular space and compels the water to follow. If the serum sodium levels rise too rapidly, the increased extracellular tonicity will continue to drive water out of the brain's cells because the brain cells do not have enough time to bring extracellular sodium into the cell, so the water will go out very fast. This can lead to cellular dysfunction and <del style="font-weight: bold; text-decoration: none;">death and finally </del>central pontine myelinolysis.</div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>It is understood that central pontine myelinolysis is caused by the rapid correction of [[hyponatremia]]. The [[CNS]] is particularly susceptible to reductions in [[plasma osmolarity]], specially during [[hyponatremia]] which is the most commonly encountered [[electrolyte disturbance]]. When a decrease in the plasma [[osmolarity]] happens, neural cells first swell but then they are able to regain their original volume through the release of inorganic and organic osmolytes and exit of osmotically obligated water. Subsequent exposure to hypertonic stress(e.g., correction of [[hyponatremia]] with hypertonic I.V. solutions)resulting from a rapid correction of [[hyponatremia]] causes the [[ions]] to quickly re-enter the intracellular space and compels the water to follow. If the serum sodium levels rise too rapidly, the increased extracellular tonicity will continue to drive water out of the brain's cells because the brain cells do not have enough time to bring extracellular sodium into the cell, so the water will go out very fast. This can lead to cellular dysfunction and central pontine myelinolysis <ins style="font-weight: bold; text-decoration: none;">and finally death</ins>.</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Pathophysiology==</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Pathophysiology==</div></td></tr>
<tr><td colspan="2" class="diff-lineno" id="mw-diff-left-l16">Line 16:</td>
<td colspan="2" class="diff-lineno">Line 16:</td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*A subsequent exposure to hypertonic stress(e.g., correction of [[hyponatremia]] with hypertonic I.V. solution's)resulting from a rapid correction of [[hyponatremia]] causes the [[ions]] to quickly re-enter the [[intracellular space]] and compels the water to follow.<ref name="pmid30357070">{{cite journal| author=Sheikh AB, Afzal RM, Sagheer S, Bukhari MM, Javed A, Nasrullah A et al. z| title=The Dilemma of Inadvertent Pontine Demyelinosis: A Review of Literature. | journal=Cureus | year= 2018 | volume= 10 | issue= 8 | pages= e3174 | pmid=30357070 | doi=10.7759/cureus.3174 | pmc=6197531 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30357070 }} </ref></div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*A subsequent exposure to hypertonic stress(e.g., correction of [[hyponatremia]] with hypertonic I.V. solution's)resulting from a rapid correction of [[hyponatremia]] causes the [[ions]] to quickly re-enter the [[intracellular space]] and compels the water to follow.<ref name="pmid30357070">{{cite journal| author=Sheikh AB, Afzal RM, Sagheer S, Bukhari MM, Javed A, Nasrullah A et al. z| title=The Dilemma of Inadvertent Pontine Demyelinosis: A Review of Literature. | journal=Cureus | year= 2018 | volume= 10 | issue= 8 | pages= e3174 | pmid=30357070 | doi=10.7759/cureus.3174 | pmc=6197531 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30357070 }} </ref></div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*If the serum sodium levels rise too rapidly, the increased [[Extracellular|extracellular tonicity]] will continue to drive water out of the brain neurons because the brain cells do not have enough time to bring [[Extracellular|extracellular sudiom]] into the cell, so the water will go out very fast instead.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref></div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*If the serum sodium levels rise too rapidly, the increased [[Extracellular|extracellular tonicity]] will continue to drive water out of the brain neurons because the brain cells do not have enough time to bring [[Extracellular|extracellular sudiom]] into the cell, so the water will go out very fast instead.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref></div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>*This can lead to cellular dysfunction and <del style="font-weight: bold; text-decoration: none;">death and finally </del>central pontine myelinolysis.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref></div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>*This can lead to cellular dysfunction and central pontine myelinolysis <ins style="font-weight: bold; text-decoration: none;">and finally death</ins>.<ref name="pmid23760391">{{cite journal| author=Khosya S, Meena H| title=Central pontine myelinolysis. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 5 | pages= 993-4 | pmid=23760391 | doi= | pmc=3734697 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760391 }} </ref></div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Genetics==</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Genetics==</div></td></tr>
</table>
M Jahan
https://www.wikidoc.org/index.php?title=Central_pontine_myelinolysis_pathophysiology&diff=1592925&oldid=prev
M Jahan: /* Microscopic Pathology */
2019-12-24T14:58:56Z
<p><span dir="auto"><span class="autocomment">Microscopic Pathology</span></span></p>
<table style="background-color: #fff; color: #202122;" data-mw="interface">
<col class="diff-marker" />
<col class="diff-content" />
<col class="diff-marker" />
<col class="diff-content" />
<tr class="diff-title" lang="en">
<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">← Older revision</td>
<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 14:58, 24 December 2019</td>
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<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*The lesions are sharply demarcated and contain sheets of lipid‐laden [[Macrophage|macrophages]] and large numbers of reactive [[Astrocyte|astrocytes]].</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*The lesions are sharply demarcated and contain sheets of lipid‐laden [[Macrophage|macrophages]] and large numbers of reactive [[Astrocyte|astrocytes]].</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Infiltration by [[Lymphocyte|lymphocytes]] is sparse or absent.</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Infiltration by [[Lymphocyte|lymphocytes]] is sparse or absent.</div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>*Axons and neurons are mostly well preserved</div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>*Axons and neurons are mostly well preserved<ins style="font-weight: bold; text-decoration: none;">.</ins></div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Symmetrically spared “islands” of myelinated white matter</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Symmetrically spared “islands” of myelinated white matter</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
</table>
M Jahan
https://www.wikidoc.org/index.php?title=Central_pontine_myelinolysis_pathophysiology&diff=1592924&oldid=prev
M Jahan at 14:56, 24 December 2019
2019-12-24T14:56:20Z
<p></p>
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">← Older revision</td>
<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 14:56, 24 December 2019</td>
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<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>* On gross pathology of patients with central pontine myelinolysis a red, central, triangular region of softening may be seen with preservation of the surrounding [[parenchyma]] on opened sagittally [[pons]] and [[Medulla oblongata|medulla]] from the ventral aspect.<ref name="pmid29177819">{{cite journal| author=Haynes HR, Gallagher PJ, Cordaro A, Likeman M, Love S| title=A case of chronic asymptomatic central pontine myelinolysis with histological evidence of remyelination. | journal=Forensic Sci Med Pathol | year= 2018 | volume= 14 | issue= 1 | pages= 106-108 | pmid=29177819 | doi=10.1007/s12024-017-9933-y | pmc=5830465 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29177819 }} </ref></div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>* On gross pathology of patients with central pontine myelinolysis a red, central, triangular region of softening may be seen with preservation of the surrounding [[parenchyma]] on opened sagittally [[pons]] and [[Medulla oblongata|medulla]] from the ventral aspect.<ref name="pmid29177819">{{cite journal| author=Haynes HR, Gallagher PJ, Cordaro A, Likeman M, Love S| title=A case of chronic asymptomatic central pontine myelinolysis with histological evidence of remyelination. | journal=Forensic Sci Med Pathol | year= 2018 | volume= 14 | issue= 1 | pages= 106-108 | pmid=29177819 | doi=10.1007/s12024-017-9933-y | pmc=5830465 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29177819 }} </ref></div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>*in cross section <del style="font-weight: bold; text-decoration: none;">sample </del>of the <del style="font-weight: bold; text-decoration: none;">midbrain </del></div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>*<ins style="font-weight: bold; text-decoration: none;">Central and symetrical [[demyelination]] in the base of the [[pons]] </ins>in cross section <ins style="font-weight: bold; text-decoration: none;">samples<ref name="pmid24887055">{{cite journal| author=Robinson CA, Adiele RC, Tham M, Lucchinetti CF, Popescu BF| title=Early and widespread injury </ins>of <ins style="font-weight: bold; text-decoration: none;">astrocytes in </ins>the <ins style="font-weight: bold; text-decoration: none;">absence of demyelination in acute haemorrhagic leukoencephalitis. | journal=Acta Neuropathol Commun | year= 2014 | volume= 2 | issue= | pages= 52 | pmid=24887055 | doi=10.1186/2051-5960-2-52 | pmc=4035095 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24887055 }} </ref></ins></div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">*</del></div></td><td colspan="2" class="diff-side-added"></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div><br /></div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div><br /></div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Microscopic Pathology==</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>==Microscopic Pathology==</div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>On microscopic histopathological analysis, the following features are characteristic findings of central pontine myelinolysis:<ref name="pmid17071802">{{cite journal| author=Love S| title=Demyelinating diseases. | journal=J Clin Pathol | year= 2006 | volume= 59 | issue= 11 | pages= 1151-9 | pmid=17071802 | doi=10.1136/jcp.2005.031195 | pmc=1860500 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17071802 }} </ref></div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>On microscopic histopathological analysis, the following features are characteristic findings of central pontine myelinolysis:<ref name="pmid17071802">{{cite journal| author=Love S| title=Demyelinating diseases. | journal=J Clin Pathol | year= 2006 | volume= 59 | issue= 11 | pages= 1151-9 | pmid=17071802 | doi=10.1136/jcp.2005.031195 | pmc=1860500 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17071802 <ins style="font-weight: bold; text-decoration: none;"> }} </ref><ref name="pmid24887055">{{cite journal| author=Robinson CA, Adiele RC, Tham M, Lucchinetti CF, Popescu BF| title=Early and widespread injury of astrocytes in the absence of demyelination in acute haemorrhagic leukoencephalitis. | journal=Acta Neuropathol Commun | year= 2014 | volume= 2 | issue= | pages= 52 | pmid=24887055 | doi=10.1186/2051-5960-2-52 | pmc=4035095 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24887055 </ins> }} </ref></div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
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<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*The lesions are sharply demarcated and contain sheets of lipid‐laden [[Macrophage|macrophages]] and large numbers of reactive [[Astrocyte|astrocytes]].</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*The lesions are sharply demarcated and contain sheets of lipid‐laden [[Macrophage|macrophages]] and large numbers of reactive [[Astrocyte|astrocytes]].</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Infiltration by [[Lymphocyte|lymphocytes]] is sparse or absent.</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Infiltration by [[Lymphocyte|lymphocytes]] is sparse or absent.</div></td></tr>
<tr><td class="diff-marker" data-marker="−"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>*Axons and <del style="font-weight: bold; text-decoration: none;">neurones </del>are mostly well preserved</div></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>*Axons and <ins style="font-weight: bold; text-decoration: none;">neurons </ins>are mostly well preserved</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Symmetrically spared “islands” of myelinated white matter</div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>*Symmetrically spared “islands” of myelinated white matter</div></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
</table>
M Jahan
https://www.wikidoc.org/index.php?title=Central_pontine_myelinolysis_pathophysiology&diff=1592923&oldid=prev
M Jahan: /* Gross Pathology */
2019-12-24T14:52:20Z
<p><span dir="auto"><span class="autocomment">Gross Pathology</span></span></p>
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">← Older revision</td>
<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 14:52, 24 December 2019</td>
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<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><br/></td></tr>
<tr><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>* On gross pathology of patients with central pontine myelinolysis a red, central, triangular region of softening may be seen with preservation of the surrounding [[parenchyma]] on opened sagittally [[pons]] and [[Medulla oblongata|medulla]] from the ventral aspect.<ref name="pmid29177819">{{cite journal| author=Haynes HR, Gallagher PJ, Cordaro A, Likeman M, Love S| title=A case of chronic asymptomatic central pontine myelinolysis with histological evidence of remyelination. | journal=Forensic Sci Med Pathol | year= 2018 | volume= 14 | issue= 1 | pages= 106-108 | pmid=29177819 | doi=10.1007/s12024-017-9933-y | pmc=5830465 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29177819 }} </ref></div></td><td class="diff-marker"></td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"><div>* On gross pathology of patients with central pontine myelinolysis a red, central, triangular region of softening may be seen with preservation of the surrounding [[parenchyma]] on opened sagittally [[pons]] and [[Medulla oblongata|medulla]] from the ventral aspect.<ref name="pmid29177819">{{cite journal| author=Haynes HR, Gallagher PJ, Cordaro A, Likeman M, Love S| title=A case of chronic asymptomatic central pontine myelinolysis with histological evidence of remyelination. | journal=Forensic Sci Med Pathol | year= 2018 | volume= 14 | issue= 1 | pages= 106-108 | pmid=29177819 | doi=10.1007/s12024-017-9933-y | pmc=5830465 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29177819 }} </ref></div></td></tr>
<tr><td colspan="2" class="diff-side-deleted"></td><td class="diff-marker" data-marker="+"></td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">*in cross section sample of the midbrain </ins></div></td></tr>
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M Jahan