We present a 46-year-old man with
central pontine myelinolysis (CPM). He had been diagnosed with
diabetes mellitus and
chronic pancreatitis. He had drunk more than 1.2 l of Japanese sake daily for 20 years and more. He developed slight reduction of consciousness,
dysarthria and
truncal ataxia 7 days after he stopped drinking. The laboratory data on admission showed
hyperosmolar hyperglycemic state, according to the following findings;
glucose 1,058 mg/dl, serum osmolality 328 mOsm/l and serum
sodium 119 mEq/l. According as administration of acetic
Ringer's solution and
insulin injection, the laboratory data 14 hours after admission showed
glucose 235 mg/dl, serum osmolality 290 mOsm/l and serum
sodium 131 mEq/l. The initial diffusion weighted images (DWI) on MRI revealed a small high signal intensity spot in the pons. The second DWI after 14 days revealed a trident-shaped hyperintensity in the pons that was compatible with CPM. His symptoms showed no remarkable changes, but susceptibility weighted images of MRI after 4 months revealed low signal intensity area in the CPM lesion that indicated pontine
hemorrhage. We speculate that marked fluctuation of serum osmotic pressure associated with the rapid change of the serum
glucose had a significant role in the pathogenesis of the present case. Therefore, we recommend gradual correction of serum
glucose and serum osmolality to maintain less than 12 mEq/l/day as correction of chronic
hyponatremia in to prevent and ameliorate pathologic condition of CPM.