Endocrinol Metab.  2011 Sep;26(3):263-267. 10.3803/EnM.2011.26.3.263.

A Case of Central Pontine Myelinolysis in a Type 2 Diabetic Patient without Electrolyte Changes

• Jo AR
• Suk JH
• Ha JK
• Jung CW
• Kim BJ
• Park SO
• Hwang SC
• Choi HW
• Kim MK

• KMID: 2169180
• DOI: http://doi.org/10.3803/EnM.2011.26.3.263

Abstract

Central pontine myelinolysis (CPM) by complicating rapid correction of severe hyponatremia has been widely reported. Additionally, CPM was occasionally reported among patients with post-liver transplantation, burns, chronic renal failure with dialysis, or other diseases associated with or not associated with other electrolyte changes or hyperosmolarity. However, there have been a few reports of CPM occurring in diabetic patients without documented electrolyte changes. This report is, to the best of our knowledge, the first report of CPM in type 2 diabetic patients without electrolyte changes in Korea. A 40-year-old man with type 2 diabetes mellitus with abruptly developed dysarthria and ataxia was admitted to our facility. He suffered from poor glucose control and multiple diabetic complications. Brain magnetic resonance imaging (MRI) revealed a well-defined bilateral symmetric hyperintense lesion in the central portion of the pons on T2- and diffusion-weighted images, which was consistent with CPM. After the patient's blood glucose and blood pressure normalized, his dysarthria and ataxia improved. Six months after discharge, follow-up MRI showed a persistent, but greatly reduced symmetric lesion in the central pons. It is certainly possible for CPM to be overlooked clinically in diabetic patients, but more cases could be diagnosed if careful attention was paid to this syndrome.

Keyword

Central pontine myelinolysis; Type 2 diabetes mellitus

MeSH Terms

Adult
Ataxia
Blood Glucose
Blood Pressure
Brain
Burns
Diabetes Complications
Diabetes Mellitus, Type 2
Dialysis
Dysarthria
Follow-Up Studies
Glucose
Humans
Hyponatremia
Kidney Failure, Chronic
Korea
Magnetic Resonance Imaging
Myelinolysis, Central Pontine
Pons
Transplants
Blood Glucose
Glucose

Figure

• 

  Fig. 1 Initial T2-weighted (A) and diffusion-weighted MRI (B) showed symmetric hyperintense area in the pons (arrows).

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  Fig. 2 T2-weighted (A) and diffusion-weighted MRI (B) six months after discharge showed still persistent, but markedly diminished hyperintense area in the pons (arrows).

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