A rare presentation of central pontine myelinolysis secondary to hyperglycaemia

Abstract

Background Central pontine myelinolysis (CPM) is a rare demyelinating disorder caused by the loss of myelin in the center of the basis pontis. CPM typically occurs with rapid correction of severe chronic hyponatremia and subsequent disturbances in serum osmolality. Although hyperglycaemia is recognized as a pathogenetic factor in serum osmolality fluctuations, CPM is rarely seen in the context of diabetes. Case presentation A 66-year-old Chinese male presented with a history of gait imbalance, mild slurred speech and dysphagia for two weeks. MRI showed the mass lesions in the brainstem, and laboratory examinations showed high blood glucose and HbA1c, as well as increased serum osmolality. The patient was diagnosed with CPM secondary to hyperosmolar hyperglyceamia and received insulin treatment as well as supportive therapy. After six weeks of followup, the patient had fully recovered to a normal state. Conclusion CPM is a potentially fatal neurological condition and can occur in uncontrolled diabetes mellitus. Early diagnosis and timely treatment are crucial for improving the prognosis.

Cavitating Osmotic Demyelination with an Unusual Pontine Appearance

“…[ 4 ] Occasionally, as in the present case, both may co-exist. [ 5 , 6 , 7 ] Several atypical radiological features were noted in our patient, including the presence of thalamic hyperintensities, involvement of the external capsule and cerebellar white matter, along with folial enhancement. Additionally, the double-barreled appearance of the pons at follow-up was reminiscent of “swimming goggles,” which has not been reported thus far.…”