Background Osmotic demyelination syndrome (ODS) is a rare condition that causes severe neurological symptoms and is commonly associated with rapid correction of hyponatremia. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome are well-known diabetic emergencies; however, the development of ODS in patients with diabetes is rare. Case Report A 70-year-old man with type 2 diabetes mellitus presented to the emergency department with lower extremity weakness, dysarthria, and gait disturbance. The patient’s diabetes management had been irregular, with self-directed and inconsistent insulin administration. Laboratory tests revealed hyperglycemia (356 mg/dL), and markedly elevated glycated hemoglobin (17%), but no hyponatremia, acidosis, high serum osmolality, or ketonuria. Brain magnetic resonance imaging revealed a high-intensity lesion in the central pons on diffusion-weighted imaging, consistent with a diagnosis of ODS. The patient’s neurological symptoms improved with insulin therapy, and he was transferred for rehabilitation on hospital day 17. Why should an emergency physician be aware of this? ODS can develop in patients with poorly controlled diabetes even in the absence of DKA or HHS. Emergency physicians should maintain a high index of suspicion for ODS in patients with nonspecific neurological symptoms, as prompt neuroimaging evaluation is warranted.
Mizu et al. (Mon,) studied this question.