Teaching NeuroImage: Central Pontine Myelinolysis in Diabetic Ketoacidosis

Central pontine myelinolysis: a rare finding in hyperosmolar hyperglycemia

“…It is reported that before the treatment of hyperglycemia and hyperosmolality (6, 7), there were cases of CPM, and our patient's CPM may also have been caused by hyperosmolality before correction. Several reports have described patients with CPM in association with a hyperosmolar hyperglycemic state or its correction (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Since there was no obvious change in osmotic pressure before and after correction, we consider that the CPM of our patient was related to the hyperosmolar state inherent in hyperglycemia.…”

“…Brain MRI remains the preferred diagnostic mode for CPM, and as described in the MRI results of this case, CPM may display a high signal on T2 and symmetric restricted diffusion in the pontine ( 10 , 20 ). Despite reports of asymmetric lesions, pontine lesions are usually symmetrical ( 21 ).…”

“…Due to the poor control of diabetes, the unstable fluctuation of blood glucose may further lead to an unstable osmotic environment and the inability of normal cell compensation (18). MRI changes related to ODS typically include high signal lesions on Brain MRI remains the preferred diagnostic mode for CPM, and as described in the MRI results of this case, CPM may display a high signal on T2 and symmetric restricted diffusion in the pontine (10,20). Despite reports of asymmetric lesions, pontine lesions are usually symmetrical (21).…”

Cavitating Osmotic Demyelination with an Unusual Pontine Appearance

“…ODS is associated with rapid electrolyte-induced osmotic shifts classically involving serum sodium but has also been reported in ketotic and non-ketotic hyperglycemia. [ 4 ] Occasionally, as in the present case, both may co-exist. [ 5 , 6 , 7 ] Several atypical radiological features were noted in our patient, including the presence of thalamic hyperintensities, involvement of the external capsule and cerebellar white matter, along with folial enhancement.…”