Osmotic Demyelination Syndrome as the Initial Manifestation of a Hyperosmolar Hyperglycemic State

Rodríguez-Velver, Karla Victoria; Soto-Garcia, Analy J.; Zapata-Rivera, Maria Azucena; Montes-Villarreal, Juan; Villarreal-Pérez, Jesús Zacarías; Rodríguez-Gutiérrez, René

doi:10.1155/2014/652523

Cited by 20 publications

(23 citation statements)

References 31 publications

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“…It is widely accepted that the most common cause of ODS is hyperosmotic stress resulting from rapid correction of severe hyponatremia [7]. Other conditions related to ODS include alcoholism, malnutrition, prolonged diuretic use, burns (in the context of hypernatremia), post-liver transplant, AIDS, folate deficiency, and hypoglycemia [6,8,9]. The association of ODS secondary to HHS has seldom been reported.…”

Section: Discussionmentioning

confidence: 99%

Serial Magnetic Resonance Imaging Findings in a Patient with Hyperglycemia-Related Osmotic Demyelination Syndrome: A Case Report

Kim

Park

2018

Preprint

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Background: The authors report serial magnetic resonance imaging findings of osmotic demyelination syndrome (ODS) related to hyperglycemia in a patient with uncontrolled diabetes mellitus. Case presentation: A 61-year-old man with diabetes was admitted for general weakness and severe thirst. A few days later, he complained of dysarthria, dysphasia, and dysmetria. On admission, he exhibited significant hyperglycemia (33.5 mmol/L [627 mg/dL]), with a glycated hemoglobin level of 18.1%. Other laboratory investigations revealed a sodium level of 133 mEq/L, potassium 3.8 mEq/L, blood urea nitrogen 43.9 mg/dL, with a calculated serum osmolality of 324 mOsm/kg. Brain magnetic resonance imaging (MRI) revealed T2 signal abnormalities that were symmetrical, non-space occupying, and located in the central pons with a peripheral sparing pattern, which were findings suggestive of ODS. In addition, subsequent MRI revealed progression of signal hyperintensity; however, the patient's symptoms were improved and he was discharged after 2 months. Conclusion: We report a rare case of hyperglycemia-related ODS that exhibited gradual progression in imaging features despite the prompt correction of blood sugar levels and improvement of neurological symptoms

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Section: Discussionmentioning

confidence: 99%

Serial Magnetic Resonance Imaging Findings in a Patient with Hyperglycemia-Related Osmotic Demyelination Syndrome: A Case Report

Kim

Park

2018

Preprint

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“…Theories proposed behind the pathogenesis of osmotic demyelination in the setting of hyperosmolar hyperglycemia are: (1) Subacute changes in brain cells secondary to hyperglycemia leading to demyelination (2); (2) rapid changes in osmolality associated with the fluctuations in serum glucose causing osmotic demyelination (4) and (3) hypertonic insult associated with hyperglycemia itself causing demyelination (5). Risk factors for CPM in diabetics include association of diabetic nephropathy requiring dialysis, hepatitis C and hypertension (6).…”

Section: Discussionmentioning

confidence: 99%

Atypical presentation of central pontine myelinolysis in hyperglycemia

Talluri¹,

Charumathi²,

Khan³

et al. 2017

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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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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“…Osmotic demyelination syndrome has seldom been reported as a complication of hyperosmolar hyperglycemia. [6][7][8][9][10][11][12][13] And extrapontine myelinolysis with hyperosmolar hyperglycemia is extremely rare, with only 2 reports to date to the best of our knowledge. 6,10…”

Section: ■ Osmotic Demyelination Syndromementioning

confidence: 99%