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      Atypical presentation of central pontine myelinolysis in hyperglycemia

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          Abstract

          Central pontine myelinolysis (CPM) usually occurs with rapid correction of severe chronic hyponatremia. Despite the pronounced fluctuations in serum osmolality, CPM is rarely seen in diabetics. This is a case report of CPM associated with hyperglycemia. A 45-year-old non-smoking and non-alcoholic African American male with past medical history of type 2 diabetes, hypertension, stage V chronic kidney disease and hypothyroidism presented with a two-week history of intermittent episodes of gait imbalance, slurred speech and inappropriate laughter. Physical examination including complete neurological assessment and fundoscopic examination were unremarkable. Laboratory evaluation was significant for serum sodium: 140 mmol/L, potassium: 3.9 mmol/L, serum glucose: 178 mg/dL and serum osmolality: 317 mosmol/kg. His ambulatory blood sugars fluctuated between 100 and 600 mg/dL in the six weeks prior to presentation, without any significant or rapid changes in his corrected serum sodium or other electrolyte levels. MRI brain demonstrated a symmetric lesion in the central pons with increased signal intensity on T2- and diffusion-weighted images. After neurological consultation and MRI confirmation, the patient was diagnosed with CPM secondary to hyperosmolar hyperglycemia. Eight-week follow-up with neurology was notable for near-complete resolution of symptoms. This case report highlights the importance of adequate blood glucose control in diabetics. Physicians should be aware of complications like CPM, which can present atypically in diabetics and is only diagnosed in the presence of a high index of clinical suspicion.

          Learning points:
          • Despite the pronounced fluctuations in serum osmolality, central pontine myelinolysis (CPM) is rarely seen in diabetics. This case report of CPM associated with hyperglycemia highlights the importance of adequate blood glucose control in diabetics.

          • Physicians should be aware of complications like CPM in diabetics.

          • CPM can present atypically in diabetics and is only diagnosed in the presence of a high index of clinical suspicion.

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          Most cited references6

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          Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes.

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            Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients.

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              Central pontine myelinolysis in a patient with hyperosmolar hyperglycemia and consistently normal serum sodium.

              Central pontine myelinolysis (CPM) is almost always described in association with a disturbance in sodium homeostasis, most commonly rapid correction of chronic hyponatremia. It has only rarely been described in patients with disturbances of serum osmolality in the absence of abnormal serum sodium concentrations.

                Author and article information

                Journal
                Endocrinol Diabetes Metab Case Rep
                Endocrinol Diabetes Metab Case Rep
                EDM
                Endocrinology, Diabetes & Metabolism Case Reports
                Bioscientifica Ltd (Bristol )
                2052-0573
                04 September 2017
                2017
                : 2017
                : 17-0064
                Affiliations
                [1 ]Internal Medicine
                [2 ]Endocrinology , Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
                Author notes
                Correspondence should be addressed to S Talluri; Email: swapnatalluri3@ 123456gmail.com
                Article
                EDM170064
                10.1530/EDM-17-0064
                5592705
                66987010-8864-4614-88b3-e6ecd010c16c
                © 2017 The authors

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

                History
                : 21 June 2017
                : 6 July 2017
                Categories
                Unique/Unexpected Symptoms or Presentations of a Disease

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