Talluri Swapna, Charumathi Raghu, Khan Muhammad, Kissell Kerri
Internal Medicine.
Endocrinology, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA.
Endocrinol Diabetes Metab Case Rep. 2017 Sep 4;2017. doi: 10.1530/EDM-17-0064. eCollection 2017.
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.
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.
中央桥脑髓鞘溶解症（CPM）通常发生在严重慢性低钠血症快速纠正之后。尽管血清渗透压有明显波动，但CPM在糖尿病患者中很少见。这是一例与高血糖相关的CPM病例报告。一名45岁、不吸烟不饮酒的非裔美国男性，有2型糖尿病、高血压、Ⅴ期慢性肾脏病和甲状腺功能减退的既往病史，出现间歇性步态失衡、言语不清和行为异常发笑两周。体格检查包括全面的神经系统评估和眼底检查均无异常。实验室检查结果显示血清钠：140 mmol/L，钾：3.9 mmol/L，血清葡萄糖：178 mg/dL，血清渗透压：317 mosmol/kg。在就诊前六周，他的门诊血糖在100至600 mg/dL之间波动，校正血清钠或其他电解质水平没有任何显著或快速变化。脑部MRI显示脑桥中央有一个对称病变，在T2加权像和弥散加权像上信号强度增加。经过神经科会诊和MRI确诊，该患者被诊断为高渗性高血糖继发的CPM。神经科八周随访时症状几乎完全缓解。该病例报告强调了糖尿病患者血糖控制达标的重要性。医生应意识到像CPM这样的并发症，其在糖尿病患者中可能表现不典型，只有在高度临床怀疑时才能确诊。
尽管血清渗透压有明显波动，但中央桥脑髓鞘溶解症（CPM）在糖尿病患者中很少见。这例与高血糖相关的CPM病例报告强调了糖尿病患者血糖控制达标的重要性。医生应意识到糖尿病患者中像CPM这样的并发症。CPM在糖尿病患者中可能表现不典型，只有在高度临床怀疑时才能确诊。
