A case of extrapontine myelinolysis associated with hyperosmolar hyperglycemic syndrome / 대한내과학회지

ABSTRACT

Hyperosmolar hyperglycemic syndrome (HHS) or hyperglycemic hyperosmolar nonketotic coma, an acute complication of type 2 diabetes mellitus, is commonly associated with hypernatremia. According to the treatment guideline of HHS and hypernatremia, plasma glucose and sodium concentration should be lowered at the recommended correction rate to prevent cerebral edema and, rarely, central pontine myelinolysis (CPM) or extrapontine myelinolysis (EPM). Recently we experienced a case of HHS with initial corrected serum sodium concentration of 198.5 mEq/L. The hypernatremia was corrected too rapidly on the first and second hospital days and the patient showed recent memory disturbance and difficulty in communication on the third hospital day. Brain MRI revealed abnormal signal intensities in the extrapontine areas, in favor of a diagnosis of EPM. We concluded that EPM of this case was induced by the rapid correction of hypernatremia.