48:
167:
391:, the extracellular tonicity increases, followed by an increase in intracellular tonicity. When the correction is too rapid, not enough time is allowed for the brain's cells to adjust to the new tonicity, namely by increasing the intracellular osmoles mentioned earlier. If the serum sodium levels rise too rapidly, the increased extracellular tonicity will continue to drive water out of the brain's cells. This can lead to cellular dysfunction and central pontine myelinolysis.
226:
437:
of critically ill patients may even be better than what is generally considered, despite severe initial clinical manifestations and a tendency by the intensivists to underestimate a possible favorable evolution. While some patients die, most survive and of the survivors, approximately one-third recover; one-third are disabled but are able to live independently; one-third are severely disabled. Permanent disabilities range from minor tremors and
241:). Apart from rapid correction of hyponatraemia, there are case reports of central pontine myelinolysis in association with hypokalaemia, anorexia nervosa when feeding is started, patients undergoing dialysis and burn victims. There is a case report of central pontine myelinolysis occurring in the context of
133:. 'Central pontine' indicated the site of the lesion and 'myelinolysis' was used to emphasise that myelin was affected. The authors intentionally avoided the term 'demyelination' to describe the condition, in order to differentiate this condition from multiple sclerosis and other neuroinflammatory disorders.
436:
Though traditionally the prognosis is considered poor, a good functional recovery is possible. All patients at risk of developing refeeding syndrome should have their electrolytes closely monitored, including sodium, potassium, magnesium, glucose and phosphate. Recent data indicate that the prognosis
412:
To minimise the risk of this condition developing from its most common cause, overly rapid reversal of hyponatremia, the hyponatremia should be corrected at a rate not exceeding 10 mmol/L/24 h or 0.5 mEq/L/h; or 18 mEq/L/48hrs; thus avoiding demyelination. No large clinical trials have
186:
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
416:
Once osmotic demyelination has begun, there is no cure or specific treatment. Care is mainly supportive. Alcoholics are usually given vitamins to correct for other deficiencies. The favourable factors contributing to the good outcome in central pontine myelinolysis without hyponatremia were:
383:
low plasma sodium (hyponatremia), the brain compensates by decreasing the levels of these osmolytes within the cells, so that they can remain relatively isotonic with their surroundings and not absorb too much fluid. The reverse is true in hypernatremia, in which the cells increase their
187:
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.
413:
been performed to examine the efficacy of therapeutic re-lowering of serum sodium, or other interventions sometimes advocated such as steroids or plasma exchange. Alcoholic patients should receive vitamin supplementation and a formal evaluation of their nutritional status.
399:
It can be diagnosed clinically in the appropriate context, but may be difficult to confirm radiologically using conventional imaging techniques. Changes are more prominent on MRI than on CT, but often take days or weeks after acute symptom onset to develop. Imaging by
55:
Axial fat-saturated T2-weighted image showing hyperintensity in the pons with sparing of the peripheral fibers, the patient was an alcoholic admitted with a serum Na of 101 treated with hypertonic saline, he was left with quadriparesis, dysarthria, and altered mental
417:
concurrent treatment of all electrolyte disturbances, early intensive care unit involvement at the advent of respiratory complications, early introduction of feeding including thiamine supplements with close monitoring of the electrolyte changes and input.
271:, inadequate thirst reception leads to excessive water intake, severely diluting serum sodium. With this excessive thirst combined with psychotic symptoms, brain damage such as central pontine myelinolysis may result from
2157:
2142:
1961:
Louis G, Megarbane B, Lavoué S, Lassalle V, Argaud L, Poussel JF, et al. (March 2012). "Long-term outcome of patients hospitalized in intensive care units with central or extrapontine myelinolysis*".
124:
Central pontine myelinolysis was first described as a disorder in 1959. The original paper described four cases with fatal outcomes, and the findings on autopsy. The disease was described as a disease of
252:. In these instances, occurrence may be entirely unrelated to hyponatremia or rapid correction of hyponatremia. It could affect patients who take some prescription medicines that are able to cross the
897:
Bernsen HJ, Prick MJ (September 1999). "Improvement of central pontine myelinolysis as demonstrated by repeated magnetic resonance imaging in a patient without evidence of hyponatremia".
2118:
2565:
932:
1403:
Leroy S, Gout A, Husson B, de
Tournemire R, Tardieu M (June 2012). "Centropontine myelinolysis related to refeeding syndrome in an adolescent suffering from anorexia nervosa".
136:
Since this original description, demyelination in other areas of the central nervous system associated with osmotic stress has been described outside the pons (extrapontine).
2656:
2222:
442:
1143:
Kato T, Hattori H, Nagato M, Kiuchi T, Uemoto S, Nakahata T, Tanaka K (April 2002). "Subclinical central pontine myelinolysis following liver transplantation".
680:
2366:
805:
Odier C, Nguyen DK, Panisset M (July 2010). "Central pontine and extrapontine myelinolysis: from epileptic and other manifestations to cognitive prognosis".
1783:
Kleinschmidt-DeMasters BK, Norenberg MD (March 1981). "Rapid correction of hyponatremia causes demyelination: relation to central pontine myelinolysis".
2555:
1042:
1221:
McKee AC, Winkelman MD, Banker BQ (August 1988). "Central pontine myelinolysis in severely burned patients: relationship to serum hyperosmolality".
508:
2651:
143:
Central pontine myelinolysis, and osmotic demyelination syndrome, present most commonly as a complication of treatment of patients with profound
17:
158:
following treatment in individuals with chronic, severe hyponatremia who have made intracellular adaptations to the prevailing hypotonicity.
992:"Psychogenic polydipsia: the result, or cause of, deteriorating psychotic symptoms? A case report of the consequences of water intoxication"
925:
1548:"Rapid development of central pontine myelinolysis after recovery from Wernicke encephalopathy: a non-alcoholic case without hyponatremia"
1043:"Central pontine myelinolysis in a patient with acute lymphoblastic leukemia after hematopoietic stem cell transplantation: a case report"
2215:
213:
In about ten per cent of people with central pontine myelinolysis, extrapontine myelinolysis is also found. In these cases symptoms of
151:), which can result from a varied spectrum of conditions, based on different mechanisms. It occurs as a consequence of a rapid rise in
2603:
2707:
2240:
202:), with other more variable neurological features associated with brainstem damage. These result from a rapid myelinolysis of the
287:
2743:
2712:
2588:
2535:
2208:
1898:"Myoinositol administration improves survival and reduces myelinolysis after rapid correction of chronic hyponatremia in rats"
2722:
2527:
2687:
2613:
2573:
1096:"Central nervous system lesions in adult liver transplant recipients: clinical review with implications for management"
2748:
2717:
2646:
2593:
2583:
2540:
2394:
2361:
2341:
644:
2682:
2314:
2598:
2510:
471:"Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients"
1853:
Brown WD (December 2000). "Osmotic demyelination disorders: central pontine and extrapontine myelinolysis".
449:. Some improvements may be seen over the course of the first several months after the condition stabilizes.
2641:
2336:
1080:
850:"Pontine and extrapontine myelinolysis: a neurologic disorder following rapid correction of hyponatremia"
2200:
401:
2578:
2463:
2253:
424:
reduces the severity of osmotic demyelination syndrome if given before attempting to correct chronic
256:
and cause abnormal thirst reception - in this scenario the central pontine myelinolysis is caused by
2172:
1448:"Wernicke's encephalopathy and central pontine myelinolysis associated with hyperemesis gravidarum"
616:
Gocht A, Colmant HJ (1987). "Central pontine and extrapontine myelinolysis: a report of 58 cases".
230:
2298:
1736:"Intracranial Lesions with Low Signal Intensity on T2-weighted MR Images - Review of Pathologies"
352:
253:
1937:
1186:
Martinez AJ, Estol C, Faris AA (May 1988). "Neurologic complications of liver transplantation".
2232:
341:
214:
170:
T2 weighted magnetic resonance scan image showing bilaterally symmetrical hyperintensities in
47:
2151:
502:
486:
272:
2621:
2545:
2278:
1792:
1693:
Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. (March 2014).
1266:"Central nervous system complications of thermal burns. A postmortem study of 139 patients"
307:
293:
Central pontine myelinolysis may also occur in patients prone to hyponatremia affected by:
778:
Musana AK, Yale SH (August 2005). "Central pontine myelinolysis: case series and review".
8:
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1987:
1938:"INOSITOL: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews"
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182:(broad arrow), suggestive of extrapontine myelinolysis (osmotic demyelination syndrome)
1497:"Wernicke's encephalopathy and central pontine myelinolysis in hyperemesis gravidarum"
1199:
1156:
140:
is the term used for both central pontine myelinolysis and extrapontine myelinolysis.
2626:
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1991:
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intracellular osmolytes so as not to lose too much fluid to the extracellular space.
280:
248:
It has also been known to occur in patients suffering withdrawal symptoms of chronic
61:
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2018:
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1604:
1364:"Central pontine myelinolysis associated with hypokalaemia in anorexia nervosa"
1315:"Central pontine myelinolysis associated with hypokalaemia in anorexia nervosa"
1058:
2166:
2005:
Young GB (March 2012). "Central pontine myelinolysis: a lesson in humility*".
818:
428:. Further study is required before using inositol in humans for this purpose.
190:
The classical clinical presentation is the progressive development of spastic
2737:
2484:
2057:
1612:
1513:
1463:
707:
425:
264:
237:
The most common cause is overly-rapid correction of low blood sodium levels (
207:
203:
191:
152:
92:
1804:
951:"Psychotic disorder in a patient with central and extrapontine myelinolysis"
755:
738:
545:
528:
452:
The degree of recovery depends on the extent of the original axonal damage.
2444:
2075:
2026:
1983:
1923:
1874:
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1234:
1207:
1121:
1008:
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629:
279:) although this is difficult to determine because such patients are often
2459:
2454:
2399:
1695:"Clinical practice guideline on diagnosis and treatment of hyponatraemia"
312:
2230:
1826:
Laureno R (1980). "Experimental pontine and extrapontine myelinolysis".
1751:
1711:
1694:
1546:
Kishimoto Y, Ikeda K, Murata K, Kawabe K, Hirayama T, Iwasaki Y (2012).
1041:
Lim KH, Kim S, Lee YS, Kim KH, Kim J, Rhee J, et al. (April 2008).
739:"Central pontine and extrapontine myelinolysis after alcohol withdrawal"
529:"Central pontine and extrapontine myelinolysis after alcohol withdrawal"
2503:
2439:
2419:
2404:
2378:
2263:
1733:
364:
363:
The currently accepted theory states that the brain cells adjust their
257:
249:
225:
126:
118:
110:
76:
2134:
660:
404:
typically demonstrates areas of hyperintensity on T2-weighted images.
2479:
2474:
2283:
2268:
2183:
1495:
Sutamnartpong P, Muengtaweepongsa S, Kulkantrakorn K (January 2013).
376:
298:
114:
106:
66:
420:
Research has led to improved outcomes. Animal studies suggest that
2469:
2258:
421:
368:
336:
155:
2273:
1649:"Axonal damage: a key predictor of outcome in human CNS diseases"
372:
175:
2188:
694:
Babar SM (October 2013). "SIADH associated with ciprofloxacin".
2248:
2161:
2146:
1896:
Silver SM, Schroeder BM, Sterns RH, Rojiani AM (January 2006).
1782:
1734:
Zimny A, Neska-Matuszewska M, Bladowska J, SÄ…siadek MJ (2015).
1692:
438:
148:
113:(treatment-induced), and is characterized by acute paralysis,
96:
468:
41:
Osmotic demyelination syndrome, central pontine demyelination
1960:
1895:
1402:
926:"Psychogenic Polydipsia (Excessive Fluid seeking Behaviour)"
2293:
581:
The
Journal of the Royal College of Physicians of Edinburgh
379:
in response to varying serum osmolality. In the context of
101:
91:
is a neurological condition involving severe damage to the
2657:
Megalencephalic leukoencephalopathy with subcortical cysts
1545:
121:(difficulty speaking), and other neurological symptoms.
1312:
1142:
574:
2039:
2367:
Lesional demyelinations of the central nervous system
2040:
Abbott R, Silber E, Felber J, Ekpo E (October 2005).
1828:
Transactions of the
American Neurological Association
283:
and have a long history of mental health conditions.
2124:
1902:
1313:
Sugimoto T, Murata T, Omori M, Wada Y (March 2003).
1220:
577:"Central pontine myelinolysis without hyponatraemia"
575:
Bose P, Kunnacherry A, Maliakal P (September 2011).
1586:
804:
260:leading to low blood sodium levels (hyponatremia).
1587:Gankam Kengne, Fabrice; Decaux, Guy (2017-09-01).
1368:Journal of Neurology, Neurosurgery, and Psychiatry
1319:Journal of Neurology, Neurosurgery, and Psychiatry
1185:
2556:Chronic inflammatory demyelinating polyneuropathy
1263:
2735:
2652:Leukoencephalopathy with vanishing white matter
1688:
1686:
1684:
1642:
1640:
1093:
570:
568:
566:
564:
2216:
736:
526:
367:by changing levels of certain osmolytes like
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1998:
1954:
1846:
1681:
1637:
1539:
1488:
1445:
1396:
1355:
1306:
1264:Winkelman MD, Galloway PG (September 1992).
1136:
1040:
1034:
989:
931:. American Psychological Society Divisions.
896:
890:
615:
507:: CS1 maint: multiple names: authors list (
1646:
1439:
1257:
1214:
1179:
1087:
847:
841:
771:
636:
561:
462:
2223:
2209:
1501:Journal of Neurosciences in Rural Practice
948:
777:
642:
609:
46:
2604:Experimental autoimmune encephalomyelitis
2065:
1913:
1759:
1710:
1664:
1620:
1563:
1522:
1512:
1471:
1379:
1338:
1281:
1111:
1094:Singh N, Yu VL, Gayowski T (March 1994).
1066:
1017:
1007:
966:
865:
754:
592:
544:
441:to signs of severe brain damage, such as
387:With correction of the hyponatremia with
2708:List of multiple sclerosis organizations
487:10.1001/archneurpsyc.1959.02340140020004
233:in the brainstem (Luxol-Fast blue stain)
224:
165:
1825:
1361:
469:Adams RD, Victor M, Mancall EL (1959).
288:hematopoietic stem cell transplantation
14:
2736:
2713:List of people with multiple sclerosis
2589:Neuromyelitis optica spectrum disorder
2536:Neuromyelitis optica spectrum disorder
2088:
522:
520:
518:
317:People with serum sodium <105 mEq/L
2204:
2004:
1852:
955:Psychiatry and Clinical Neurosciences
693:
161:
2688:Mitochondrial DNA depletion syndrome
2574:Acute disseminated encephalomyelitis
848:Karp BI, Laureno R (November 1993).
687:
275:caused by excess intake of fluids, (
1915:10.1097/01.jnen.0000195938.02292.39
1446:Bergin PS, Harvey P (August 1992).
515:
24:
1647:Medana IM, Esiri MM (March 2003).
923:
737:Yoon B, Shim YS, Chung SW (2008).
527:Yoon B, Shim YS, Chung SW (2008).
358:
245:, in the absence of hyponatremia.
25:
2760:
2112:
1699:European Journal of Endocrinology
1047:Journal of Korean Medical Science
990:Gill M, McCauley M (2015-01-21).
229:Loss of myelinated fibers at the
2718:Multiple sclerosis drug pipeline
2594:Diffuse myelinoclastic sclerosis
2584:Marburg acute multiple sclerosis
2541:Diffuse myelinoclastic sclerosis
2395:Management of multiple sclerosis
2362:Radiologically isolated syndrome
2342:Expanded Disability Status Scale
2042:"Osmotic demyelination syndrome"
1867:10.1097/00019052-200012000-00014
1565:10.2169/internalmedicine.51.7498
1283:10.1097/00005792-199209000-00002
1113:10.1097/00005792-199403000-00004
968:10.1111/j.1440-1819.2007.01648.x
938:from the original on 2015-04-07.
867:10.1097/00005792-199311000-00001
683:from the original on 2012-03-06.
2315:Diagnosis of multiple sclerosis
2082:
1930:
1889:
1819:
1776:
1727:
1580:
983:
942:
917:
286:It has been observed following
2599:Tumefactive multiple sclerosis
2511:Research in multiple sclerosis
2231:Demyelinating diseases of the
2121:Images of Osmotic Myelinolysis
2091:"Central Pontine Myelinolysis"
949:Lim L, Krystal A (June 2007).
798:
730:
645:"Central pontine myelinolysis"
178:(long arrow), with sparing of
138:Osmotic demyelination syndrome
18:Osmotic demyelination syndrome
13:
1:
2744:Demyelinating diseases of CNS
2089:Luzzio C (17 November 2015).
1200:10.1016/S0733-8619(18)30873-9
1157:10.1016/S0387-7604(02)00013-X
696:The Annals of Pharmacotherapy
455:
2678:Central pontine myelinolysis
2647:Pelizaeus–Merzbacher disease
2642:Metachromatic leukodystrophy
2337:Clinically isolated syndrome
2308:Investigations and diagnosis
2019:10.1097/CCM.0b013e31823b8e0b
1976:10.1097/CCM.0b013e318236f152
1855:Current Opinion in Neurology
1593:Kidney International Reports
1589:"Hyponatremia and the Brain"
1374:(4): 663, author reply 663.
431:
407:
394:
333:Severe electrolyte disorders
297:Severe liver disease (e.g.,
89:Central pontine myelinolysis
33:Central pontine myelinolysis
7:
2683:Marchiafava–Bignami disease
1740:Polish Journal of Radiology
10:
2765:
1605:10.1016/j.ekir.2017.08.015
1059:10.3346/jkms.2008.23.2.324
996:Case Reports in Psychiatry
475:AMA Arch Neurol Psychiatry
198:, and emotional lability (
2700:
2670:
2612:
2579:Balo concentric sclerosis
2564:
2526:
2519:
2493:
2387:
2307:
2239:
2128:
1362:Keswani SC (April 2004).
819:10.1007/s00415-010-5486-7
643:Lampl C, Yazdi K (2002).
220:
210:tracts in the brainstem.
117:(difficulty swallowing),
72:
60:
54:
45:
37:
32:
2749:Electrolyte disturbances
2058:10.1136/bmj.331.7520.829
1514:10.4103/0976-3147.105608
1464:10.1136/bmj.305.6852.517
899:Acta Neurologica Belgica
708:10.1177/1060028013502457
231:basilar part of the pons
1805:10.1126/science.7466381
1145:Brain & Development
618:Clinical Neuropathology
353:Wernicke encephalopathy
109:). It is predominately
2520:Demyelinating diseases
2233:central nervous system
2007:Critical Care Medicine
1964:Critical Care Medicine
1417:10.1055/s-0032-1307458
743:Alcohol and Alcoholism
594:10.4997/JRCPE.2011.305
533:Alcohol and Alcoholism
342:hyperemesis gravidarum
269:psychogenic polydipsia
234:
183:
1331:10.1136/jnnp.74.3.353
1235:10.1212/wnl.38.8.1211
756:10.1093/alcalc/agn050
546:10.1093/alcalc/agn050
443:spastic quadriparesis
228:
174:(small, thin arrow),
169:
2622:Adrenoleukodystrophy
2546:MOG antibody disease
2348:Serological and CSF
2299:Uhthoff's phenomenon
1666:10.1093/brain/awg061
807:Journal of Neurology
346:Hyponatremia due to
2450:Monomethyl fumarate
1797:1981Sci...211.1068K
1791:(4486): 1068–1070.
1752:10.12659/PJR.892146
1712:10.1530/eje-13-1020
1009:10.1155/2015/846459
348:peritoneal dialysis
254:blood-brain barrier
215:Parkinson's disease
200:pseudobulbar affect
2551:Multiple sclerosis
2435:Interferon beta-1b
2430:Interferon beta-1a
2425:Glatiramer acetate
2415:Diroximel fumarate
2388:Approved treatment
2241:Signs and symptoms
1188:Neurologic Clinics
649:European Neurology
447:locked-in syndrome
389:intravenous fluids
277:primary polydipsia
243:refeeding syndrome
235:
217:may be generated.
196:pseudobulbar palsy
184:
162:Signs and symptoms
2731:
2730:
2696:
2695:
2627:Alexander disease
2410:Dimethyl fumarate
2352:Oligoclonal bands
2320:McDonald criteria
2198:
2197:
2052:(7520): 829–830.
1659:(Pt 3): 515–530.
1558:(12): 1599–1603.
1552:Internal Medicine
1458:(6852): 517–518.
702:(10): 1359–1363.
661:10.1159/000047939
281:institutionalised
86:
85:
27:Medical condition
16:(Redirected from
2756:
2524:
2523:
2494:Other treatments
2372:Dawson's fingers
2225:
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2013:(3): 1026–1027.
2002:
1996:
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1543:
1537:
1536:
1526:
1516:
1492:
1486:
1485:
1475:
1443:
1437:
1436:
1400:
1394:
1393:
1383:
1359:
1353:
1352:
1342:
1310:
1304:
1303:
1285:
1261:
1255:
1254:
1229:(8): 1211–1217.
1218:
1212:
1211:
1183:
1177:
1176:
1140:
1134:
1133:
1115:
1091:
1085:
1084:
1079:. Archived from
1070:
1038:
1032:
1031:
1021:
1011:
987:
981:
980:
970:
946:
940:
939:
937:
930:
921:
915:
914:
894:
888:
887:
869:
845:
839:
838:
813:(7): 1176–1180.
802:
796:
795:
775:
769:
768:
758:
734:
728:
727:
691:
685:
684:
640:
634:
633:
613:
607:
606:
596:
572:
559:
558:
548:
524:
513:
512:
506:
498:
466:
329:Anorexia nervosa
304:Liver transplant
105:(an area of the
50:
30:
29:
21:
2764:
2763:
2759:
2758:
2757:
2755:
2754:
2753:
2734:
2733:
2732:
2727:
2723:Pathophysiology
2692:
2666:
2662:CAMFAK syndrome
2632:Canavan disease
2608:
2560:
2515:
2489:
2383:
2303:
2235:
2229:
2199:
2194:
2193:
2137:
2115:
2110:
2109:
2099:
2097:
2087:
2083:
2038:
2034:
2003:
1999:
1959:
1955:
1946:
1944:
1936:
1935:
1931:
1894:
1890:
1851:
1847:
1824:
1820:
1781:
1777:
1732:
1728:
1691:
1682:
1645:
1638:
1585:
1581:
1544:
1540:
1493:
1489:
1444:
1440:
1405:Neuropediatrics
1401:
1397:
1360:
1356:
1311:
1307:
1262:
1258:
1219:
1215:
1184:
1180:
1141:
1137:
1092:
1088:
1039:
1035:
988:
984:
947:
943:
935:
928:
922:
918:
895:
891:
846:
842:
803:
799:
776:
772:
735:
731:
692:
688:
641:
637:
614:
610:
573:
562:
525:
516:
500:
499:
467:
463:
458:
434:
410:
397:
361:
359:Pathophysiology
273:hyperosmolarity
223:
180:globus pallidus
172:caudate nucleus
164:
28:
23:
22:
15:
12:
11:
5:
2762:
2752:
2751:
2746:
2729:
2728:
2726:
2725:
2720:
2715:
2710:
2704:
2702:
2698:
2697:
2694:
2693:
2691:
2690:
2685:
2680:
2674:
2672:
2668:
2667:
2665:
2664:
2659:
2654:
2649:
2644:
2639:
2637:Krabbe disease
2634:
2629:
2624:
2618:
2616:
2610:
2609:
2607:
2606:
2601:
2596:
2591:
2586:
2581:
2576:
2570:
2568:
2562:
2561:
2559:
2558:
2553:
2548:
2543:
2538:
2532:
2530:
2521:
2517:
2516:
2514:
2513:
2508:
2507:
2506:
2497:
2495:
2491:
2490:
2488:
2487:
2482:
2477:
2472:
2467:
2464:+hyaluronidase
2457:
2452:
2447:
2442:
2437:
2432:
2427:
2422:
2417:
2412:
2407:
2402:
2397:
2391:
2389:
2385:
2384:
2382:
2381:
2376:
2375:
2374:
2369:
2364:
2356:
2355:
2354:
2346:
2345:
2344:
2339:
2330:
2329:
2327:Poser criteria
2324:
2323:
2322:
2311:
2309:
2305:
2304:
2302:
2301:
2296:
2291:
2289:Optic neuritis
2286:
2281:
2276:
2271:
2266:
2261:
2256:
2251:
2245:
2243:
2237:
2236:
2228:
2227:
2220:
2213:
2205:
2196:
2195:
2192:
2191:
2180:
2169:
2154:
2138:
2133:
2132:
2130:
2129:Classification
2123:
2122:
2114:
2113:External links
2111:
2108:
2107:
2081:
2032:
1997:
1970:(3): 970–972.
1953:
1929:
1888:
1861:(6): 691–697.
1845:
1818:
1775:
1726:
1680:
1636:
1579:
1538:
1487:
1438:
1411:(3): 152–154.
1395:
1354:
1325:(3): 353–355.
1305:
1276:(5): 271–283.
1256:
1213:
1194:(2): 327–348.
1178:
1151:(3): 179–182.
1135:
1106:(2): 110–118.
1086:
1083:on 2009-02-27.
1053:(2): 324–327.
1033:
982:
961:(3): 320–322.
941:
916:
905:(3): 189–193.
889:
860:(6): 359–373.
840:
797:
770:
749:(6): 647–649.
729:
686:
635:
624:(6): 262–270.
608:
587:(3): 211–214.
560:
539:(6): 647–649.
514:
460:
459:
457:
454:
433:
430:
409:
406:
396:
393:
360:
357:
356:
355:
350:
344:
339:
334:
331:
326:
321:
318:
315:
310:
305:
302:
267:patients with
222:
219:
163:
160:
84:
83:
74:
70:
69:
64:
58:
57:
52:
51:
43:
42:
39:
35:
34:
26:
9:
6:
4:
3:
2:
2761:
2750:
2747:
2745:
2742:
2741:
2739:
2724:
2721:
2719:
2716:
2714:
2711:
2709:
2706:
2705:
2703:
2699:
2689:
2686:
2684:
2681:
2679:
2676:
2675:
2673:
2669:
2663:
2660:
2658:
2655:
2653:
2650:
2648:
2645:
2643:
2640:
2638:
2635:
2633:
2630:
2628:
2625:
2623:
2620:
2619:
2617:
2615:
2611:
2605:
2602:
2600:
2597:
2595:
2592:
2590:
2587:
2585:
2582:
2580:
2577:
2575:
2572:
2571:
2569:
2567:
2563:
2557:
2554:
2552:
2549:
2547:
2544:
2542:
2539:
2537:
2534:
2533:
2531:
2529:
2525:
2522:
2518:
2512:
2509:
2505:
2502:
2501:
2499:
2498:
2496:
2492:
2486:
2485:Teriflunomide
2483:
2481:
2478:
2476:
2473:
2471:
2468:
2465:
2461:
2458:
2456:
2453:
2451:
2448:
2446:
2443:
2441:
2438:
2436:
2433:
2431:
2428:
2426:
2423:
2421:
2418:
2416:
2413:
2411:
2408:
2406:
2403:
2401:
2398:
2396:
2393:
2392:
2390:
2386:
2380:
2377:
2373:
2370:
2368:
2365:
2363:
2360:
2359:
2358:Radiological
2357:
2353:
2350:
2349:
2347:
2343:
2340:
2338:
2335:
2334:
2332:
2331:
2328:
2325:
2321:
2318:
2317:
2316:
2313:
2312:
2310:
2306:
2300:
2297:
2295:
2292:
2290:
2287:
2285:
2282:
2280:
2277:
2275:
2272:
2270:
2267:
2265:
2262:
2260:
2257:
2255:
2252:
2250:
2247:
2246:
2244:
2242:
2238:
2234:
2226:
2221:
2219:
2214:
2212:
2207:
2206:
2203:
2190:
2186:
2185:
2181:
2179:
2175:
2174:
2170:
2168:
2164:
2163:
2159:
2155:
2153:
2149:
2148:
2144:
2140:
2139:
2136:
2131:
2127:
2120:
2117:
2116:
2096:
2092:
2085:
2077:
2073:
2068:
2063:
2059:
2055:
2051:
2047:
2043:
2036:
2028:
2024:
2020:
2016:
2012:
2008:
2001:
1993:
1989:
1985:
1981:
1977:
1973:
1969:
1965:
1957:
1943:
1942:www.webmd.com
1939:
1933:
1925:
1921:
1916:
1911:
1907:
1903:
1899:
1892:
1884:
1880:
1876:
1872:
1868:
1864:
1860:
1856:
1849:
1841:
1837:
1833:
1829:
1822:
1814:
1810:
1806:
1802:
1798:
1794:
1790:
1786:
1779:
1771:
1767:
1762:
1757:
1753:
1749:
1745:
1741:
1737:
1730:
1722:
1718:
1713:
1708:
1704:
1700:
1696:
1689:
1687:
1685:
1676:
1672:
1667:
1662:
1658:
1654:
1650:
1643:
1641:
1632:
1628:
1623:
1618:
1614:
1610:
1606:
1602:
1598:
1594:
1590:
1583:
1575:
1571:
1566:
1561:
1557:
1553:
1549:
1542:
1534:
1530:
1525:
1520:
1515:
1510:
1506:
1502:
1498:
1491:
1483:
1479:
1474:
1469:
1465:
1461:
1457:
1453:
1449:
1442:
1434:
1430:
1426:
1422:
1418:
1414:
1410:
1406:
1399:
1391:
1387:
1382:
1377:
1373:
1369:
1365:
1358:
1350:
1346:
1341:
1336:
1332:
1328:
1324:
1320:
1316:
1309:
1301:
1297:
1293:
1289:
1284:
1279:
1275:
1271:
1267:
1260:
1252:
1248:
1244:
1240:
1236:
1232:
1228:
1224:
1217:
1209:
1205:
1201:
1197:
1193:
1189:
1182:
1174:
1170:
1166:
1162:
1158:
1154:
1150:
1146:
1139:
1131:
1127:
1123:
1119:
1114:
1109:
1105:
1101:
1097:
1090:
1082:
1078:
1074:
1069:
1064:
1060:
1056:
1052:
1048:
1044:
1037:
1029:
1025:
1020:
1015:
1010:
1005:
1001:
997:
993:
986:
978:
974:
969:
964:
960:
956:
952:
945:
934:
927:
920:
912:
908:
904:
900:
893:
885:
881:
877:
873:
868:
863:
859:
855:
851:
844:
836:
832:
828:
824:
820:
816:
812:
808:
801:
793:
789:
785:
781:
774:
766:
762:
757:
752:
748:
744:
740:
733:
725:
721:
717:
713:
709:
705:
701:
697:
690:
682:
678:
674:
670:
666:
662:
658:
654:
650:
646:
639:
631:
627:
623:
619:
612:
604:
600:
595:
590:
586:
582:
578:
571:
569:
567:
565:
556:
552:
547:
542:
538:
534:
530:
523:
521:
519:
510:
504:
496:
492:
488:
484:
481:(2): 154–72.
480:
476:
472:
465:
461:
453:
450:
448:
444:
440:
429:
427:
426:hyponatraemia
423:
418:
414:
405:
403:
392:
390:
385:
382:
378:
374:
370:
366:
354:
351:
349:
345:
343:
340:
338:
335:
332:
330:
327:
325:
322:
319:
316:
314:
311:
309:
306:
303:
300:
296:
295:
294:
291:
289:
284:
282:
278:
274:
270:
266:
265:schizophrenic
261:
259:
255:
251:
246:
244:
240:
232:
227:
218:
216:
211:
209:
208:corticospinal
205:
204:corticobulbar
201:
197:
193:
192:quadriparesis
188:
181:
177:
173:
168:
159:
157:
154:
150:
146:
141:
139:
134:
132:
128:
122:
120:
116:
112:
108:
104:
103:
98:
94:
93:myelin sheath
90:
82:
78:
75:
71:
68:
65:
63:
59:
53:
49:
44:
40:
36:
31:
19:
2677:
2566:Inflammatory
2445:Mitoxantrone
2279:Incontinence
2182:
2171:
2156:
2141:
2098:. Retrieved
2094:
2084:
2049:
2045:
2035:
2010:
2006:
2000:
1967:
1963:
1956:
1945:. Retrieved
1941:
1932:
1908:(1): 37–44.
1905:
1901:
1891:
1858:
1854:
1848:
1831:
1827:
1821:
1788:
1784:
1778:
1743:
1739:
1729:
1705:(3): G1-47.
1702:
1698:
1656:
1652:
1599:(1): 24–35.
1596:
1592:
1582:
1555:
1551:
1541:
1507:(1): 39–41.
1504:
1500:
1490:
1455:
1451:
1441:
1408:
1404:
1398:
1371:
1367:
1357:
1322:
1318:
1308:
1273:
1269:
1259:
1226:
1222:
1216:
1191:
1187:
1181:
1148:
1144:
1138:
1103:
1099:
1089:
1081:the original
1050:
1046:
1036:
999:
995:
985:
958:
954:
944:
919:
902:
898:
892:
857:
853:
843:
810:
806:
800:
786:(6): 56–60.
783:
779:
773:
746:
742:
732:
699:
695:
689:
652:
648:
638:
621:
617:
611:
584:
580:
536:
532:
503:cite journal
478:
474:
464:
451:
435:
419:
415:
411:
398:
386:
365:osmolarities
362:
324:Malnutrition
320:Severe burns
292:
285:
262:
247:
239:hyponatremia
236:
212:
189:
185:
145:hyponatremia
142:
137:
135:
131:malnutrition
123:
100:
88:
87:
81:malnutrition
2460:Ocrelizumab
2455:Natalizumab
2400:Alemtuzumab
1834:: 354–358.
655:(1): 3–10.
313:Hypokalemia
97:nerve cells
38:Other names
2738:Categories
2614:Hereditary
2528:Autoimmune
2504:Daclizumab
2440:Laquinimod
2420:Fingolimod
2405:Cladribine
2379:Frexalimab
2264:Dysarthria
2254:Depression
1947:2021-10-14
1002:: 846459.
924:Donald H.
456:References
308:Alcoholism
258:polydipsia
250:alcoholism
127:alcoholics
119:dysarthria
111:iatrogenic
77:Alcoholism
2480:Siponimod
2475:Ponesimod
2333:Clinical
2284:Nystagmus
2269:Dysphagia
2184:SNOMED CT
1992:205542487
1746:: 40–50.
1613:2468-0249
1223:Neurology
432:Prognosis
408:Treatment
395:Diagnosis
377:glutamine
299:cirrhosis
115:dysphagia
107:brainstem
67:Neurology
62:Specialty
2470:Ozanimod
2259:Diplopia
2100:14 March
2095:Medscape
2076:16210283
2027:22343870
1984:22036854
1924:16410747
1883:36063964
1875:11148672
1770:25628772
1721:24569125
1675:12566274
1631:29340311
1574:22728498
1533:23546346
1433:22751051
1425:22473289
1390:15026526
1349:12588925
1300:12872586
1270:Medicine
1251:42068902
1173:22140717
1165:11934516
1130:37808180
1100:Medicine
1077:18437020
1028:25688318
977:17472602
933:Archived
911:10544728
884:24829955
854:Medicine
835:25301314
827:20148334
792:16218318
765:18678596
724:36759747
716:24259701
681:Archived
677:46885398
669:11803185
603:21949915
555:18678596
495:13616772
422:inositol
369:inositol
337:HIV/AIDS
156:tonicity
2500:Former
2274:Fatigue
2189:6807001
2178:D017590
2152:8A45.31
2067:1246086
1840:7348981
1813:7466381
1793:Bibcode
1785:Science
1761:4307690
1622:5762960
1524:3579041
1482:1393001
1473:1882865
1381:1739009
1340:1738317
1292:1522803
1243:3399069
1208:3047544
1122:8152365
1068:2526450
1019:4320790
876:8231786
630:3322623
381:chronic
373:betaine
176:putamen
99:in the
2249:Ataxia
2119:MedPix
2074:
2064:
2025:
1990:
1982:
1922:
1881:
1873:
1838:
1811:
1768:
1758:
1719:
1673:
1629:
1619:
1611:
1572:
1531:
1521:
1480:
1470:
1431:
1423:
1388:
1378:
1347:
1337:
1298:
1290:
1249:
1241:
1206:
1171:
1163:
1128:
1120:
1075:
1065:
1026:
1016:
975:
909:
882:
874:
833:
825:
790:
763:
722:
714:
675:
667:
628:
601:
553:
493:
439:ataxia
375:, and
221:Causes
149:sodium
73:Causes
56:status
2701:Other
2671:Other
2167:G37.2
1988:S2CID
1879:S2CID
1653:Brain
1429:S2CID
1296:S2CID
1247:S2CID
1169:S2CID
1126:S2CID
936:(PDF)
929:(PDF)
880:S2CID
831:S2CID
720:S2CID
673:S2CID
153:serum
147:(low
2294:Pain
2173:MeSH
2102:2017
2072:PMID
2023:PMID
1980:PMID
1920:PMID
1871:PMID
1836:PMID
1809:PMID
1766:PMID
1717:PMID
1671:PMID
1627:PMID
1609:ISSN
1570:PMID
1529:PMID
1478:PMID
1421:PMID
1386:PMID
1345:PMID
1288:PMID
1239:PMID
1204:PMID
1161:PMID
1118:PMID
1073:PMID
1024:PMID
1000:2015
973:PMID
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