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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Central Pontine Myelinolysis (CPM) | 2A0 Case 2 History
Case 2 History ---- The decedent was a 58-year-old female with a history of poorly controlled, insulin-dependent type 2 diabetes, chronic kidney disease, systemic hypertension, and optic neuropathy who suffered cardiac arrest and was not able to be resuscitated. Her prior medical history included multiple hospital admissions for a hyperosmolar non-ketotic state with blood glucose in the 600-700s (HbA1c 13.9%). On 12/6/2016, the patient presented to BJH ED with slurred speech, gait instability, right-sided sensory changes, and generalized fatigue. She was found to be in nonketotic hyperosmolar state with blood glucose of 737 on admission. A brain MRI on this day showed a T2 hyperintense, diffusion-restricting area in the central pons that measured 1.8 x 1.2 cm, thought to be CPM. The brain MR also showed chronic small vessel ischemic disease evidenced by multifocal areas of FLAIR/T2 hyperintensity in the subcortical and periventricular white matter. The patient did not have deterioration in her neurological status throughout the admission. Further history is not available.
