Central pontine myelinolysis mimicking glioma in diabetes: A case report

Abstract

BACKGROUND Central pontine myelinolysis (CPM) usually occurs during rapid correction of serum osmolality, typically with brainstem lesions presenting uniform signals following enhancement on magnetic resonance imaging (MRI). We report a case of CPM caused by diabetes, which was characterized by glioma-like imaging features and the patient responded well to corticosteroids. CASE SUMMARY A 49-year-old man with type 2 diabetes was admitted due to numbness and weakness for 6 mo with progressive aggravation for 2 wk. His complete blood count, serum electrolytes, renal and liver function parameters were within the normal range. MRI showed mass lesions in the brainstem, with unusually inhomogeneous signal intensity after contrast-enhanced scans. His symptoms worsened after hypoglycemic therapy. Due to his clinical history and examination results, CPM was considered the most likely diagnosis. Treatment with corticosteroids was administered with a methylprednisolone pulse in the acute phase followed by dose tapering. During the 8-mo follow-up period, his clinical symptoms and imaging features significantly improved. CONCLUSION Diabetes could rarely be accompanied by CPM, and patients who experience this neurological complication could benefit from corticosteroid treatment. Clinicians should recognize the special relationship between diabetes and CPM, and improve awareness of early identification and appropriate treatment.

Radiological Appearance and Imaging Techniques in the Diagnosis of Advanced Central Pontine Myelinolysis

“…On magnetic resonance spectroscopy, the acute phase is marked by a drop in the N-acetyl aspartate (NAA)/creatine (Cr) ratio, an increase in the choline (Cho)/Cr ratio and a lactate/lipid peak. This displays a further rise in the Cho/Cr ratio and a decrease in the NAA/Cr ratio in the later phase [ 18 ].…”

“…The imaging features could also mimic a glioma due to similarity in the pathological aetiology resulting from damage in the blood-brain barrier, which produces abnormal inhomogeneous signal intensity on contrast-enhanced MRI. In such cases, follow-up could be beneficial for a definite diagnosis [ 18 ].…”