Serial Magnetic Resonance Imaging Findings in a Patient with Hyperglycemia-Related Osmotic Demyelination Syndrome: A Case Report

Background: The authors report serial magnetic resonance imaging findings of osmotic demyelination syndrome (ODS) related to hyperglycemia in a patient with uncontrolled diabetes mellitus. Case presentation: A 61-year-old man with diabetes was admitted for general weakness and severe thirst. A few days later, he complained of dysarthria, dysphasia, and dysmetria. On admission, he exhibited significant hyperglycemia (33.5 mmol/L [627 mg/dL]), with a glycated hemoglobin level of 18.1%. Other laboratory investigations revealed a sodium level of 133 mEq/L, potassium 3.8 mEq/L, blood urea nitrogen 43.9 mg/dL, with a calculated serum osmolality of 324 mOsm/kg. Brain magnetic resonance imaging (MRI) revealed T2 signal abnormalities that were symmetrical, non-space occupying, and located in the central pons with a peripheral sparing pattern, which were findings suggestive of ODS. In addition, subsequent MRI revealed progression of signal hyperintensity; however, the patient's symptoms were improved and he was discharged after 2 months. Conclusion: We report a rare case of hyperglycemia-related ODS that exhibited gradual progression in imaging features despite the prompt correction of blood sugar levels and improvement of neurological symptoms