Shi XY, Cai MT, Shen H, Zhang JX. Central pontine myelinolysis mimicking glioma in diabetes: A case report. World J Clin Cases 2021; 9(18): 4837-4843 [PMID: 34222456 DOI: 10.12998/wjcc.v9.i18.4837]
Corresponding Author of This Article
Jin-Xia Zhang, MD, Doctor, Department of Clinical Psychology (Sleep Medical Center), Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, No. 1630 Huanding Road, Hangzhou 310000, Zhejiang Province, China. zhangjinxia20000@163.com
Research Domain of This Article
Neuroimaging
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xiao-Yong Shi, Department of Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Meng-Ting Cai, Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
Hao Shen, Department of Neurology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310000, Zhejiang Province, China
Jin-Xia Zhang, Department of Clinical Psychology (Sleep Medical Center), Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
Author contributions: Shi XY contributed literature review, initial draft manuscript preparation; Cai MT contributed literature review, initial draft manuscript preparation, provided radiology images; Shen H contributed patient management, provided clinical data; Zhang JX contributed concept and design of the study, final approval of the version to be published; all authors read and approved the final manuscript.
Informed consent statement: The patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Xia Zhang, MD, Doctor, Department of Clinical Psychology (Sleep Medical Center), Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, No. 1630 Huanding Road, Hangzhou 310000, Zhejiang Province, China. zhangjinxia20000@163.com
Received: February 5, 2021 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
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.
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.
