Chronic hyperglycemia-related central pontine myelinolysis: A case report and a literature review.

INTRODUCTION

Central pontine myelinolysis (CPM) is a rare condition that has been reported to occur in association with rapid correction of hyponatremia. Chronic hyperglycemia is an extremely rare cause of CPM with no other metabolic disturbances. Our aim was to describe the case of a patient who presented with CPM associated with chronic hyperglycemia.

OBSERVATION

We report the case of a 55-year-old male with a personal history of diabetes mellitus who presented, over two months, gait disorders, slurred speech, and dysphagia. All laboratory tests were within normal limits except for glycated hemoglobin level which was high at 12%. Calculated serum osmolality level was normal at 309.8 mOsm/kg. Brain magnetic resonance imaging was consistent with the diagnosis of CPM. Patient's medical condition improved by optimizing blood glucose levels, physical rehabilitation and speech therapy.

CONCLUSION

This case highlights the hypothesis of chronic hyperglycemia being the direct cause of CPM. The underlying mechanism might be the toxicity of varying blood glucose levels towards the oligodendrocytes.