Asymptomatic Pontine Lesion and Diabetic Amyotrophy after Rapid Improvement of Poor Glycemic Control in a Patient with Type 1 Diabetes

Intern Med. 2019 Dec 1;58(23):3433-3439. doi: 10.2169/internalmedicine.2835-19. Epub 2019 Aug 6.

Abstract

We herein report a 28-year-old woman with type 1 diabetes with an asymptomatic pontine lesion and diabetic amyotrophy. She had suffered from diabetes from 10 years old. Treatment in a hospital reduced the hemoglobin A1c level from 14.2% to 7.2% for approximately 2 months. She suffered from acute-onset pain and weakness of the lower limb muscles without central nervous system manifestations. Magnetic resonance imaging showed high-intensity lesions at the brainstem and lower limb muscles on T2-weighted images. These findings and symptoms gradually resolved. Rapid treatment of poor glycemic control might increase the risk of asymptomatic pontine lesions and diabetic amyotrophy.

Keywords: asymptomatic pontine lesion; diabetic amyotrophy; glycemic control; magnetic resonance imaging; osmotic demyelination syndrome; type 1 diabetes.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Blood Glucose / metabolism
  • Brain Diseases / etiology*
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / diet therapy*
  • Diabetes Mellitus, Type 1 / drug therapy
  • Diabetic Neuropathies / complications
  • Diabetic Neuropathies / diet therapy*
  • Diabetic Neuropathies / drug therapy
  • Female
  • Glycated Hemoglobin / metabolism
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Insulin / therapeutic use
  • Lumbosacral Plexus
  • Magnetic Resonance Imaging
  • Muscle Weakness / etiology
  • Pain / complications
  • Pain / diet therapy
  • Pain / drug therapy
  • Peripheral Nervous System Diseases / complications
  • Peripheral Nervous System Diseases / diet therapy
  • Peripheral Nervous System Diseases / drug therapy
  • Pons*
  • Treatment Outcome

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin

Supplementary concepts

  • Neuropathy, Painful