Extrapontine myelinolysis in a 4 year old with diabetic ketoacidosis

Lalitha Sivaswamy, Samir Karia

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Extrapontine and central pontine myelinolysis (EPM/CPM) are rare events in pediatric neurology but can have devastating consequences. They are most commonly associated with rapid correction of hyponatremia but have been reported in other situations as well. This condition is relatively more common in adult neurology, not surprisingly, as alcoholism and associated malnutrition are often predisposing conditions. There have been few case reports in children with regards to this. We describe a 4-year old who presented with focal neurological deficits in the setting of diabetic ketoacidosis and the ensuing underlying osmotic imbalances. The patient made a remarkable recovery with no deficits of note-cognitive or motor. To our knowledge this is the youngest case reported so far of EPM in a child with diabetic ketoacidosis. The history of the condition, early animal experiments, clinicopathologic correlates, previous case reports and other scenarios in which this unusual event can occur are discussed-though the exact pathogenesis of this condition still remains unclear. We hope to bring to the attention of clinicians caring for children in the acute care setting, the importance of gradual correction of serum osmolality to reduce morbidity and mortality.

Original languageEnglish
Pages (from-to)389-393
Number of pages5
JournalEuropean Journal of Paediatric Neurology
Volume11
Issue number6
DOIs
StatePublished - Nov 2007

Keywords

  • Diabetic ketoacidosis
  • Extrapontine myelinolysis
  • Hyperosmolality
  • Hyponatremia
  • Magnetic resonance imaging-myelinolyis

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