A rare presentation of central pontine myelinolysis secondary to hyperglycaemia

• Published in: BMC endocrine disorders Vol. 23; no. 1; p. 106
• Main Authors: Sun, Wen-Ping, Wang, Ying-Di, Gao, Song, Wang, Yi-Fan, Li, Da-Wei
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.05.2023; BioMed Central; BMC
• Subjects: Aged; Alcoholism; Asymptomatic; Ataxia; Blood sugar; Brain stem; Case Report; Case reports; Central pontine myelinolysis; Chronic illnesses; Demyelination; Diabetes; Diabetes mellitus; Diuretics; Dysarthria; Dysphagia; Gait; Glucose; Glycosylated hemoglobin; Health aspects; Humans; Hyperglycaemia; Hyperglycemia; Hyperglycemia - complications; Hyponatremia; Insulin; Magnetic Resonance Imaging; Male; Malnutrition; Myelin; Myelinolysis, Central Pontine - diagnostic imaging; Myelinolysis, Central Pontine - etiology; Neurological complications; Osmosis; Osmotic demyelination syndrome; Osmotic pressure; Patients; Sodium; Transplants & implants; Central pontine myelinolysis; Osmotic demyelination syndrome; Hyperglycaemia
• ISSN: 1472-6823; 1472-6823
• DOI: 10.1186/s12902-023-01361-y

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. 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. 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.