Central Pontine Lesions Observed with MRI in Four Diabetic Patients

Abstract

We report four diabetic patients with a central pontine lesion on magnetic resonance imaging (MRI). All patients also had hypertension, diabetic neuropathy and nephropathy, and three had chronic hepatitis C. Their neurological symptoms were disproportionately mild compared with the MRI features, which were of high intensity on T2-weighted images, but were less prominent on T1-and diffusion-weighted images. A subclinical pontine lesion was found in two patients who had undergone MRI previously. We consider that diabetes mellitus is an important factor for developing a pontine lesion with or without symptoms, probably in association with hepato-renal problems and hypertension.

The Development of Central Pontine Myelinolysis in a Type 1 Diabetic Patient With Anti-Insulin Antibody and Similar Clinical Manifestations to Autoimmune Polyglandular Syndrome

“…Serum levels of BUN, sodium and glucose have been used for calculation of serum osmolality, indicating an importance of these parameters for serum osmolality [6]. Diabetes also has been suggested to be a risk factor for CPM [7]. The development of CPM in patients with diabetic ketoacidosis (one case) and HHS (one case) was reported [8,9].…”

Rapid Development of Central Pontine Myelinolysis after Recovery from Wernicke Encephalopathy: A Non-alcoholic Case without Hyponatremia

“…Blood sugar levels and serum osmolality were not varied apparently in the present patient. Normonatremic CPM was reported previously in diabetic patients (23,24). Therefore, the myelin and glia of the central pons might be more vulnerable to subtle fluctuations of blood sugar levels and serum sodium or phosphorus levels under thiamine deficiency or its supplementation.…”

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

“…Two cases of CPM as an unusual complication of diabetes were briefly reported a decade ago, and four diabetic patients with CPM on magnetic resonance imaging (MRI) were recently reported [12,13]. This would be the first report of CPM in type 2 diabetic patients without electrolyte changes in Korea.…”

“…Since the pontine lesions reported in diabetic patients without documented electrolyte changes are exclusive case reports of several patients, these conditions are thought to be rare [12,13]. Two cases of CPM as an unusual complication of diabetes were briefly reported a decade ago, and four diabetic patients with CPM on magnetic resonance imaging (MRI) were recently reported [12,13].…”

“…There are a few reports of CPM occurring in diabetic patients without documented electrolyte changes [12,13]. About a decade ago, Casey et al [12] briefly reported two cases of CPM as an unusual complication of diabetes.…”