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

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Published Nov 9, 2025
https://doi.org/10.62438/tunismed.v103i9.5750
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Vol. 103 No. 9 (2025): Tunis Med sept 2025

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Mohamed Slim Majoul
Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis, Tunisia
Amira Souissi
Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis,Faculty of Medicine of Tunis, 1007, University of Tunis El Manar, . Tunisia
Amal Atrous
Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis, Tunisia
Saloua Mrabet
Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis,Faculty of Medicine of Tunis, 1007, University of Tunis El Manar, Tunisia
Alya Gharbi
Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis,Faculty of Medicine of Tunis, 1007, University of Tunis El Manar, Tunisia
Youssef Abida
Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis,Faculty of Medicine of Tunis, 1007, University of Tunis El Manar, Tunisia
Amina Nasri
Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis,Faculty of Medicine of Tunis, 1007, University of Tunis El Manar, Tunisia
Amina Gargouri Berrechid
Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis,Faculty of Medicine of Tunis, 1007, University of Tunis El Manar, Tunisia
Imen Kacem
Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis,Faculty of Medicine of Tunis, 1007, University of Tunis El Manar, Tunisia
Riadh Gouider
Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health LR 18SP03, Razi University Hospital - Manouba, Tunis,Faculty of Medicine of Tunis, 1007, University of Tunis El Manar, Tunisia

Abstract

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.

Keywords:

Case report, diabetes , osmotic demyelination syndrome, sodium, white matter

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