Hyperglycemia, hypernatremia, and hyperchloremia leading to pontine central myelinolysis : a case report and review of literature

Background We report a rare case of pontine central myelinolysis caused by hyperglycemia, hypernatremia, and hyperchloremia and present a literature review. This paper also explains the pathogenesis and synergistic effects of hyperglycemia and hyponatremia in causing central pontine myelinolysis. Case presentation A 59-year-old male presented with a 15-day history of dysphagia and choking on water. Clinical manifestations were dysarthria, mild dysphagia, and tetanic muscle strength grade 4. Cranial magnetic resonance imaging (MRI) showed a characteristic “batwing”-like lesion at the base of the cerebral bridge, and he was treated with symptomatic supportive therapy, such as menthol + deguelin insulin to lower blood glucose. One week later, blood glucose, blood sodium and blood chloride were found to be normal, and the symptoms of swallowing and limb weakness basically disappeared, but the “bat-wing”-like foci in the brainstem could still be seen in the MRI. Conclusions To our knowledge, this is the first report of central myelinolysis of the cerebral bridges due to hyperglycemia with hypernatremia and hyperchloremia. Timely improvement of cranial imaging evaluation for early diagnosis and treatment can rapidly improve the symptoms and avoid leaving serious sequelae.