Published online Jun 26, 2021. doi: 10.12998/wjcc.v9.i18.4837
Peer-review started: February 5, 2021
First decision: March 7, 2021
Revised: March 9, 2021
Accepted: March 31, 2021
Article in press: March 31, 2021
Published online: June 26, 2021
Processing time: 125 Days and 21.4 Hours
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.
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.
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.
Core Tip: Central pontine myelinolysis (CPM) usually occurs during rapid correction of serum osmolality. We describe a 49-year-old man with type 2 diabetes who developed CPM without a history of hyponatremia or other common causes. Lesions in his brainstem showed atypical glioma-like inhomogeneous signal intensity on contrast-enhanced magnetic resonance imaging. He recovered after methylprednisolone pulse therapy in the acute phase and subsequent dose tapering. Our patient revealed an unusual cause and imaging presentation of CPM, implying the benefits of corticosteroid therapy to outcomes. Thus, it might be helpful for clinicians on diagnostic and therapeutic decision in the future.