Central pontine myelinolysis caused by hyperglycemia: A case report and mechanistic review.

This report highlights a rare case of a man in his 50s with central pontine myelinolysis who initially presented with dysphagia and dysarthria. The patient also exhibited unsteady gait, dizziness, and weakness in all extremities. Imaging studies revealed a typical "bat-wing" lesion at the base of the pons. The patient was diagnosed with central pontine myelinolysis secondary to a diabetic hyperglycemic hyperosmolar state complicated with hypernatremia. Following insulin therapy and rehydration, his symptoms were resolved within 1 week, while the imaging-detected lesions persisted. In most cases, central pontine myelinolysis develops due to the rapid correction of chronic hyponatremia; central pontine myelinolysis resulting from a hyperglycemic hyperosmolar state combined with hypernatremia is extremely rare. This case suggests that the coexistence of a hyperglycemic hyperosmolar state and hypernatremia can lead to central pontine myelinolysis, with a synergistic interaction between their pathogenic mechanisms. It emphasizes that in diabetic patients with poor glycemic control presenting with neurological symptoms, the possibility of central pontine myelinolysis should be vigilantly considered. Furthermore, this case supplements the understanding of the etiology and pathogenesis of central pontine myelinolysis, reminding clinicians to pay attention to central pontine myelinolysis caused by nontraditional factors.