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KMID : 0927720100110040337
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Korean Clinical Diabetes
2010 Volume.11 No. 4 p.337 ~ p.341
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A Case of Central Pontine Myelinolysis Associated with Hyperglycemic Hyperosmolar Syndrome and Consistently Normal Serum Sodium
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Moon Hyun-Jin
Park Kang-Seo
Park Chan-Woong
Kim Ki-Bang
Kim Yong-Hwan
Ryu Ah-Jeong
Park Se-Young
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Abstract
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Central pontine myelinolysis (CPM) is a demyelinating disorder that affects the pons and is characterized by disturbance of consciousness, quadriparesis and dysarthria. CPM may occur in a variety of clinical settings, but is particularly common following rapid correction of severe hyponatremia. CPM may develop as a result of rapid shifts in plasma osmolality during the treatment of hyperglycemic hyperosmolar syndrome (HHS) in some cases, but few reports have described HHS itself as a cause of CPM without rapid electrolyte correction. We present the case of a 62-year old man who presented to the emergency department with a history of unconsciousness for one day. His plasma glucose level was 1177 mg/dL and plasma sodium level was 124 mEq/L. Magnetic resonance imaging revealed a pontine lesion consistent with CPM. The patient received intensive treatment with intravenous insulin and 0.9% normal saline and made a gradual recovery over several weeks. In summary, we report a case of CPM without rapid electrolyte correction in a patient with HHS.
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KEYWORD
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Central pontine, Hyperglycemic hyperosmolar nonketotic coma, Myelinolysis
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