BMJ Case Reports 2017; doi:10.1136/bcr-2016-219148
  • Unusual presentation of more common disease/injury

Osmotic demyelination syndrome in type 1 diabetes in the absence of dyselectrolytaemia: an overlooked complication?

  1. Mohit Shah
  1. Department of Neurology, Sawai Mansingh Medical College and Hospital, Jaipur, Rajasthan, India
  1. Correspondence to Dr Banshi Lal Kumawat, kumawatbl04{at}
  • Accepted 25 April 2017
  • Published 12 May 2017


Central pontine myelinolysis (CPM) is a demyelinating disorder of central nervous system which involves central portion of the pons and sometimes extrapontine areas also. It is commonly reported in settings of hyponatraemia or its rapid correction, but in the last few years it has also been reported in patients with diabetes in the absence of electrolyte disturbances or correction of serum osmolality. Here we report a case of a 20-year-old female patient, with a known history of type 1 diabetes mellitus, who presented with acute onset spastic quadriparesis with dysarthria and mild ataxia which evolved over 2 weeks. Her MRI brain showed well-defined, bilateral symmetric hyperintense lesion involving central pons showing area of diffusion restriction which was consistent with CPM. Patient was treated conservatively and improved over a period of few weeks. To diagnose more number of cases, we should not overlook CPM in patients with diabetes.


  • Contributors Patient management, investigations and manuscript writing was performed under the guidance of CS and BLK, by active efforts of MP and MS.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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