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BrainWaves #47 Holy osmosis!!

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.

Originally released: July 18, 2017

In 1959, Adams and colleagues described a few patients who developed a rapid flaccid quadriparesis following fluid resuscitation for malnutrition and chronic alcoholism. Twenty years later, we learned that this occurs as a consequence of rapid correction of hyponatremia. But this isn't the only cause of the osmotic demyelination syndrome. Hear Dr. Joshua VanDerWerf discuss the history and clinical relevance of this unusual critical care scenario.

BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice.


Adams RD, Victor M, Mancall EL. Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients. AMA Arch Neurol Psychiatry 1959;81(2):154-72. PMID 13616772

Gocht A, Colmant HJ. Central pontine and extrapontine myelinolysis: a report of 58 cases. Clin Neuropathol 1987;6(6):262-70. PMID 3322623

Kleinschmidt-Demasters BK, Rojiani AM, Filley CM. Central and extrapontine myelinolysis: then...and now. J Neuropathol Exp Neurol 2006;65(1):1-11. PMID 16410743

Martin RJ. Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes. J Neurol Neurosurg Psychiatry 2004;75 Suppl 3(Suppl 3):iii22-8. PMID 15316041

Menger H, Jörg J. Outcome of central pontine and extrapontine myelinolysis (n = 44). J Neurol 1999;246(8):700-5. PMID 10460448

Siegler JE, Wang AR, Vanderwerf JD. Normonatremic osmotic demyelination in the setting of acquired immune deficiency syndrome and malnutrition: case report and literature review. J Neurovirol 2016;22(6):876-9. PMID 27405987

Wright DG, Laureno R, Victor M. Pontine and extrapontine myelinolysis. Brain 1979;102(2):361-85. PMID 455045

We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode’s original release date.

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